Granulation
Airway granulation is commonly encountered in infants with BPD who are treated with prolonged intubation or tracheotomy and can occur throughout the airway.(16, 20, 67, 75) Granulation tissue of the trachea an lobar bronchi result from a malpositioned endotracheal tube or suction trauma. Patients may demonstrate minimal symptoms if the granulation tissue is small, but more severe granulation can create airway stenosis that results in air trapping and respiratory distress or complete airway occlusion that results in atelectasis.(75, 76) A properly positioned artificial airway and appropriate endotracheal suction depth can both prevent and treat traumatic granulation tissue in the trachea and bronchi in majority of patients.(75) In more severe cases, treatment with topical steroids and antibiotics drops can be effective (Fig. 4A-D). A variety of endoscopic techniques have been described for management of tracheal and bronchial granulation tissue including electrocautery, argon laser, cryotherapy, and balloon dilation, though none of these techniques have been rigorously studied in neonates.(75-79)