Abstract 1133 Poster Session II, Sunday, 5/2 (poster 11)

Background: Long term intubation and ventilatory support for neonates with respiratory distress syndrome has resulted in a new group of patients who are tracheotomy dependent secondary to airway stenosis. Clarification of contributing factors may facilitate prevention of stenosis.

Objective: To obtain in vivo bacterial colonization profiles at three sites of the airway in intubated neonates and characterize a potential contributing factor in the development of subglottic stenosis.

Methods: A case series of twenty two neonates admitted to the Neonatal Intensive Care Unit at a tertiary care center who required intubation for more than 24 hours (Range: 1-15 days). Cultures were taken from 3 sites of the endotracheal tube immediately following extubation. These sites corresponded to the lower trachea, the subglottis, and the oropharynx. This allowed for non-invasive sampling at specific levels of the airway. Data collected included gender, race, length of intubation, antibiotic usage, comorbidities, gestational age at delivery and extubation, crown-rump length, weight, radiographic distance from tube tip to carina, and culture results.

Main Outcome Measures: Bacterial and fungal cultures taken from 3 endotracheal tube segments for each extubation.

Results: A statistically significant difference (p<0.05) was found in colonization rates between patients intubated for <72 hours and those intubated for longer periods. There was no significant difference in bacterial profile between the three sites.

Conclusion: The data demonstrate that colonization of an indwelling object in the neonatal airway increases with the duration of intubation. Furthermore, it appears that 72 hours represents a critical period in the formation of such a biofilm. This biofilm may contribute to the chondritis known to precede the development of subglottic stenosis related to intubation. Further studies may suggest ways to interrupt this process and reduce the incidence of airway injury.