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)