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Midfacial Hypoplasia Associated With Long-term Intubation for Bronchopulmonary Dysplasia FREE

Avi Rotschild, MD; Penelope J. Dison, MB, MRCP(UK); David Chitayat, MD; Alfonso Solimano, MD, FRCP(C)
[+] Author Affiliations

Accepted for publication June 27, 1990.

Presented in part as a poster exhibit at the meeting of the Society for Pediatric Research, Washington, DC, May 1, 1989, and the 14th Annual Conference on Neonatal/Perinatal Medicine, Section on Perinatal Pediatrics, District VIII of the American Academy of Pediatricians, Anchorage, Alaska, May 25-27, 1989.

Reprint requests to British Columbia's Children's Hospital, Room 1N1, 4480 Oak St, Vancouver, British Columbia, Canada V6H 3V4 (Dr Solimano).


Am J Dis Child. 1990;144(12):1302-1306. doi:10.1001/archpedi.1990.02150360024012.
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• Six preterm infants with bronchopulmonary dysplasia were nasotracheally intubated for 68 to 243 days. Gestational age at birth ranged from 24 to 35 weeks. Endotracheal tube size was changed to account for growth and varied from 2.5 to 4.0 mm. These infants developed features of midfacial hypoplasia, namely, depressed nasal bridge, small-tipped nose, long philtrum, underdeveloped malar areas, and carplike mouth. These features have not been associated with long-term intubation in premature infants. We suggest that features of prolonged nasotracheal intubation, such as direct compression by the tube and the method of tube fixation, decreased air flow through the developing nares and sinuses and reduced faciomuscular activity, resulting in the observed midfacial hypoplasia. The degree to which growth corrects these deformations is unknown.

(AJDC. 1990;144:1302-1306)

REFERENCES

Hawkins DB.  Hyaline membrane disease of the neonate: prolonged intubation in management: effects on the larynx . Laryngoscope . 1978;;88:201-224.
McMillan DD, Rademaker AW, Buchan KA, Reid A, Machin G, Sauve RS.  Benefits of orotracheal and nasotracheal intubation in neonates requiring ventilatory assistance . Pediatrics . 1986;; 77:39-44.
Saunders BC, Easa D, Slaughter RJ.  Acquired palatal groove in neonates: a report of two cases . J Pediatr . 1976;;89:988-989.
Duke PM, Coulson JD, Santos JI, Johnson JD.  Cleft palate associated with prolonged orotracheal intubation in infancy . J Pediatr . 1976;;89:990-991.
Erenberg A, Nowak AJ.  Palatal groove formation in neonates and infants with orotracheal tubes . AJDC . 1984;;138:974-975.
Molteni RA, Bumstead DH.  Development and severity of palatal grooves in orally intubated newborns: effect of 'soft' endotracheal tubes . AJDC . 1986;;140:357-359.
Moylan FMB, Seldin EB, Shannon DC, Todres ID.  Defective primary dentition in survivors of neonatal mechanical ventilation . J Pediatr . 1980;;96:106-108.
Boice JB, Krous HF, Foley JM.  Gingival and dental complications of orotracheal intubation . JAMA . 1976;;236:957-958.
Jung AL, Thomas GK.  Stricture of the nasal vestibule: a complication of nasotracheal intubation in newborn infants . J Pediatr . 1974;;85:412-414.
Pettett G, Merenstein GB.  Nasal erosion with nasotracheal intubation . J Pediatr . 1975;; 87:149-150.
Hanson JW, Smith DW, Cohen MM.  Prominent lateral palatine ridges: developmental and clinical relevance . J Pediatr . 1976;;89:54-58.
Behrstock B, Ramos A, Kaufman N.  Does prolonged oral intubation contribute to medial hypertrophy of the lateral palatine ridges and possibly to iatrogenic cleft palate? J Pediatr . 1977;;91:171. Letter.

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References

Hawkins DB.  Hyaline membrane disease of the neonate: prolonged intubation in management: effects on the larynx . Laryngoscope . 1978;;88:201-224.
McMillan DD, Rademaker AW, Buchan KA, Reid A, Machin G, Sauve RS.  Benefits of orotracheal and nasotracheal intubation in neonates requiring ventilatory assistance . Pediatrics . 1986;; 77:39-44.
Saunders BC, Easa D, Slaughter RJ.  Acquired palatal groove in neonates: a report of two cases . J Pediatr . 1976;;89:988-989.
Duke PM, Coulson JD, Santos JI, Johnson JD.  Cleft palate associated with prolonged orotracheal intubation in infancy . J Pediatr . 1976;;89:990-991.
Erenberg A, Nowak AJ.  Palatal groove formation in neonates and infants with orotracheal tubes . AJDC . 1984;;138:974-975.
Molteni RA, Bumstead DH.  Development and severity of palatal grooves in orally intubated newborns: effect of 'soft' endotracheal tubes . AJDC . 1986;;140:357-359.
Moylan FMB, Seldin EB, Shannon DC, Todres ID.  Defective primary dentition in survivors of neonatal mechanical ventilation . J Pediatr . 1980;;96:106-108.
Boice JB, Krous HF, Foley JM.  Gingival and dental complications of orotracheal intubation . JAMA . 1976;;236:957-958.
Jung AL, Thomas GK.  Stricture of the nasal vestibule: a complication of nasotracheal intubation in newborn infants . J Pediatr . 1974;;85:412-414.
Pettett G, Merenstein GB.  Nasal erosion with nasotracheal intubation . J Pediatr . 1975;; 87:149-150.
Hanson JW, Smith DW, Cohen MM.  Prominent lateral palatine ridges: developmental and clinical relevance . J Pediatr . 1976;;89:54-58.
Behrstock B, Ramos A, Kaufman N.  Does prolonged oral intubation contribute to medial hypertrophy of the lateral palatine ridges and possibly to iatrogenic cleft palate? J Pediatr . 1977;;91:171. Letter.

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