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A Communication Service for Physicians from CHOC and CHOC at Mission. Please Note: Physician Connection is no longer being printed and is now available electronically. Please visit our blog at http://docs.chocchildrens.org for the latest articles for our physician community. You can also receive our electronic Physician Connection newsletter in your inbox by subscribing to our mailing list: http://www.choc.org/subscribe

NIH Grant to Study Neonatal Subglottic Stenosis, Edema

CHOC Children’s pediatric otolaryngologist Gurpreet Ahuja, M.D., is the clinical coinvestigator on a team led by Brian Wong, M.D., a University of California, Irvine, otolaryngologist, that is the recipient of a five-year, $3.2 million National Institutes of Health grant to study the effectiveness of optical coherence tomography (OCT) in monitoring the neonatal airway and diagnosing changes that may lead to subglottic stenosis.

Dr. Ahuja, who will lead the clinical end of this research study, has collaborated with Dr. Wong in conducting similar OCT studies at UC Irvine, in recent years. The researchers hope that findings from this latest study will ultimately result in a modality that eliminates the need to repeatedly extubate and reintubate ventilatordependent neonates.

This close collaboration between the clinicians at CHOC and the researchers and scientists at UC Irvine is the most exciting example to date of the synergies between the two affiliates that are expected to further the health and well-being of children in Southern California.

OCT utilizes near-infrared interferometry to produce cross-sectional images of living tissue of near-histologic quality, with a resolution in excess of 10-mcm and to depths of nearly 2 mm. This non-invasive optical imaging technique can distinguish epithelium from underlying tissue microstructures, providing information that is considerably superior to current MRI, CT or ultrasound capabilities.

During the first phase of the five-year study, Dr. Ahuja will work with UC Irvine researchers to develop a more advanced optic probe that may be passed through an endotracheal tube to image the neonatal airway. The second phase involves the use of OCT imaging on rabbit models, after which morphology results will be compared with histological data.

The final phase will take place at CHOC and at UC Irvine, where Dr. Ahuja and his team will perform transendotracheal tube OCT imaging on 200 intubated neonates. They will then attempt to correlate the morphologic and structural information obtained from OCT with physiologic and functional variables such as the neonate’s gestational age, weight and number of failed extubations.

From this study, the team intends to better define the potential role of OCT in monitoring progression of pathophysiologic changes during intubation, and understanding of the in vivo growth and development of the neonatal airway, thereby attempting to identify a better way to predict successful airway extubation.

“Our hope is that the application of OCT becomes ubiquitous in NICUs, so that reconstructive surgeries for subglottic stenosis caused by prolonged or repeated intubations may be avoided,” Dr. Ahuja said.

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Children's Hospital of Orange County is affiliated with UC Irvine Healthcare and UC Irvine School of Medicine

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