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This paper describes the potential oral complications in preterm infants who have undergone orotracheal intubation. Neonatal intubation may have adverse effects on the developing deciduous teeth, oral soft tissues, and even the permanent teeth. However, endotracheal intubation may be essential for the survival of premature infants, owing to incompl...
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Context 1
... in preterm infants classified the palatal shape of neonates into square, narrow, and ovoid. A narrow palate (67.6%) was more frequently observed than the square (14.7%) or ovoid (17.7%) morphology in neonates who had undergone intubation for 7 days or longer [37]. The narrow palatal morphology is maintained even after the patient has fully grown (Fig. 4). ...
Citations
... Outcomes of several previous European studies suggest that individuals who experienced preterm birth tend to show malocclusions due to disharmonious facial growth [37]. Although controversial, many previous malocclusion studies were based on the assumption that life-supporting equipment maintained in the oral cavity of preterm infants is the principal causal contributor to malocclusions [38,39]. However, the findings here indicate that a more plausible pathophysiology for faulty facial ...
Preterm human infants often show periodic breathing (PB) or apnea of prematurity (AOP), breathing patterns which are accompanied by intermittent hypoxia (IH). We examined cause-effect relationships between transient IH and reduced facial bone growth using a rat model. Neonatal pups from 14 timed pregnant Sprague-Dawley rats were randomly assigned to an IH condition, with oxygen altering between 10% and 21% every 4 min for 1 h immediately after birth, or to a litter-matched control group. The IH pups were compared with their age- and sex-matched control groups in body weight (WT), size of facial bones and nor-epinephrine (NE) levels in blood at 3, 4, and 5-weeks. Markedly increased activity of osteoclasts in sub-condylar regions of 3-week-old IH-treated animals appeared, as well as increased numbers of sympathetic nerve endings in the same region of tissue sections. Male IH-pups showed significantly higher levels of NE levels in sera at 3, 4 as well as 5-week-old time points. NE levels in 4- and-5-week-old female pups did not differ significantly. Intercondylar Width, Mandible Length and Intermolar Width measures consistently declined after IH insults in 3- and 4-week-old male as well as female animals. Three-week-old male IH-pups only showed a significantly reduced (p < 0.05) body weight compared to those of 3-week controls. However, female IH-pups were heavier than age-matched controls at all 3 time-points. Trabecular bone configuration, size of facial bones, and metabolism are disturbed after an IH challenge 1 h immediately after birth. The findings raise the possibility that IH, introduced by breathing patterns such as PB or AOP, induce significantly impaired bone development and metabolic changes in human newborns. The enhanced NE outflow from IH exposure may serve a major role in deficient bone growth, and may affect bone and other tissue influenced by that elevation.
... Although laryngoscopy and orotracheal intubation are safe procedures, there is low risk of cervical or neck injury, laryngotracheal trauma, stenosis of the larynx, dysphagia, and/or vocal cord paralysis [13,14]. Several studies have shown oral and dental complications associated with orotracheal intubation [15,16]; however, a few reports suggest the possibility of dilaceration and impaction of primary incisors related to oral intubation. ...
... Mechanical ventilation using techniques such as orotracheal intubation is essential for survival in preterm infants with respiratory problems [11,12]. The common use of orotra-cheal intubation can be attributed to its procedural simplicity and safety; however, studies have reported oral complications related to its use [15,16]. Moreover, because intubation in preterm infants is very difficult due to poor view of the vocal cords, dental damage and trauma during laryngoscopy are not uncommon [13,17]. ...
Dental complications such as defective alveolar bone development, delayed eruption, and tooth impaction are related to neonatal oral intubation. This case report presents an example of potential complications that occur in children who have undergone oral intubation as neonates. A 20-month-old girl visited our pediatric clinic. We observed delayed, non-erupted teeth #51, #71, and #81 and determined a history of intubation during the neonatal period as a related factor. After 22 months of observation, tooth #71 erupted spontaneously. After 40 months of monitoring, teeth #51 and #81 were extracted surgically, and normal permanent teeth erupted six months later. This study is helpful for pediatric anesthesiologists, pediatricians, and dentists who diagnose and treat eruption disorders of the primary dentition.
... Some treatments and techniques to sustain life in preterm VLBW and ELBW infants have a negative impact on oral development. The developmental enamel defects (DDE) of the primary incisors, dilacerations of the primary incisors and anomalies of the hard palate may be connected with laryngoscopies and orotracheal intubations [5][6][7] . Preterm VLBW and ELBW infants are also at increased risk of delayed tooth eruption, DDE in permanent dentition, tooth discoloration and tooth crown dimension changes [8][9][10][11][12] . ...
Aims:
The aim of the present study was to evaluate the general and oral health status of a group of preterm one-year-old very low (VLBW) and extremely low birthweight (ELBW) infants and make a comparison with full-term one-year-old normal birthweight infants (NBW).
Methods:
A cross-sectional study was conducted in 102 one-year-old preterm VLBW and ELBW infants, and the data obtained were compared to 87 one-year-old full-term NBW infants. The infants' medical histories were obtained from hospital records and interviews with the mothers. The oral cavities of all infants were examined under the same conditions. The chi-square test, Pearson's chi-square test of independence and Mann-Whitney test were used for the statistical evaluation, with p < 0.05 considered statistically significant. Relative risk (RR) and 95% confidence interval (CI) estimates for variables significantly associated with oral findings were calculated.
Results:
Both perinatal variables (gestational age, mode of delivery, birthweight, Apgar score, resuscitation, orotracheal intubation and presence of intraoral pathology) and neonatal variables (antibiotic treatment and infections) had a significant association with prematurity, VLBW and ELBW. The one-year-old preterm VLBW and ELBW infants frequently suffered from general diseases, frequently received regular medication and had fewer erupted primary teeth; they also had a higher prevalence of developmental defects of the enamel and deformations of the hard palate.
Conclusion:
This study confirmed anamnestic, medical and oral differences between one-year-old preterm VLBW and ELBW and full-term NBW infants.
About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.
Expertise in neonatal airway management requires an understanding of early human anatomical development as well as a set of clinical skills to provide safe mask ventilation and tracheal intubation in this extremely small-sized population. Since neonatal airway experiences are not a daily occurrence in most anesthesiology training programs, this skill set is acquired only after repeated patient encounters over many years or decades. In this chapter, we review the foundations upon which management of the neonatal airway is based. The chapter is divided into three sections: (1) anatomy and physiology of the neonatal upper airway, (2) techniques for standard neonatal airway management, and (3) techniques for managing the anatomically abnormal neonatal airway.KeywordsUpper airway anatomyNeonatal airway managementUpper airway reflexesLaryngeal mask airwaysSupraglottic devicesOrotracheal intubationLaryngoscopyNasotracheal intubationIntubation in neonates
The rate of preterm birth is increasing worldwide and preterm infants are susceptible to oral health problems. Hence, this study aimed to investigate the effect of premature birth on dietary and oral characteristics as well as dental treatment experiences of preterm infants using a nationwide cohort study. Data was retrospectively analyzed from National Health Screening Program for Infants and Children (NHSIC) of the National Health Insurance Service of Korea. 5% sample of children born between 2008 and 2012 who completed first or second infant health screening were included and divided into full-term and preterm-birth groups. Clinical data variables such as dietary habits, oral characteristics, and dental treatment experiences were investigated and comparatively analyzed. Preterm infants showed significantly lower rates of breastfeeding at 4-6 months (p<0.001), delayed start of weaning food at 9-12 months (p<0.001), higher rates of bottle feeding at 18-24 months (p<0.001), poor appetite at 30-36 months (p<0.001) and higher rates of improper swallowing and chewing function at 42-53 months (p = 0.023) than full-term infants. Preterm infants also had eating habits leading to poor oral conditions and higher percentage of absence of dental visit compared to full-term infants (p = 0.036). However, dental treatments including 1-visit pulpectomy (p = 0.007) and 2-visit pulpectomy (p = 0.042) significantly decreased when oral health screening was completed at least once. The NHSIC can be an effective policy for oral health management in preterm infants.
