Necrotizing tracheobronchitis. An ischemic lesion
J. B. Hanson, G. Waldstein, J. A. Hernandez and L. L. Fan
Department of Perinatology, Children's Hospital, Denver, CO 80218.
Neonates with necrotizing tracheobronchitis present a diverse clinical
spectrum from asymptomatic disease to severe airway obstruction. A
retrospective clinicopathologic study of 206 neonatal autopsy reports
spanning a three-year period yielded 122 cases of necrotizing
tracheobronchitis with an incidence of 59%. All study patients received
treatment prior to the development of high-frequency ventilator jet,
oscillator, or interruption. The site and submucosal depth of airway
involvement was variable. The most commonly affected anatomic site was the
middle or thoracic trachea (56%). The common cause identified was severe
ischemia to the airway mucosa and submucosa, occurring with profound birth
asphyxia and/or shock. The presence of ischemia supports the concept that
decreased tracheoperfusion may be an important factor in the development of
tracheobronchial abnormalities.
