Diagnosis of Subglottic Stenosis and Edema in Neonates Using OCT

描述(申请人提供)：我们寻求开发关键技术来帮助早产儿和新生儿在生命的最初几天存活下来，并避免由声门下狭窄(SGS)引起的严重呼吸道并发症，SGS是儿童最常见的获得性喉部异常，也是婴儿中最常见的需要气管切开的异常。SGS是可以预防的，是在生命的关键最初几天通过气管插管引起的。在早产儿和新生儿中，这种情况可能未被发现或表现为危及生命的事件。随着新生儿重症监护技术的进步，更好地治疗甚至预防声门下狭窄的能力有所提高，但诊断仍然是一个持续存在争议和争论的来源。声门下组织性质细腻，容易受损，迅速发展为水肿性改变，容易发生炎症、疤痕形成和狭窄。外科内窥镜检查仍然是诊断SGS的金标准。不幸的是，手术需要全身麻醉，仅限于表面解剖的特征，不能提供对上皮下层组织的详细分析。这种临床情况通常是复杂的，因为新生儿的肺、心脏和低氧阈值可能会由于对生理应激的有限耐受性而推迟对呼吸道的评估。本质上，评估新生儿呼吸道的最终挑战是将诊断性创伤和生理压力降至最低，同时准确地描述喉部组织。光学相干层析成像(OCT)是一种利用光来产生分辨率超过105m的活体组织的高分辨率图像的成像方式。OCT允许人们以实时帧速率基于组织光学属性来区分上皮和底层组织微结构。使用OCT可以非侵入性地表征活体组织，远远超过目前的MRI、CT和超声波的成像能力。我们建议设计和构建高速、高分辨率的OCT技术结合基于三维MEMS的探头来成像新生儿重症监护室中的新生儿和婴儿的呼吸道，并确定OCT在诊断这些危重患者的声门下呼吸道疾病的发生和发展中的潜在作用。首先，我们将在SGS的新西兰白兔模型中优化技术，并将OCT与传统显微镜进行比较。然后，我们将对奥兰治县重症监护室加州大学欧文分校儿童医院200名插管新生儿的声门下气道进行成像，并将OCT获得的形态和结构特征与生理和功能变量(如胎龄、体重和失败拔管次数)进行关联，以确定可以更好地预测成功拔管的变量，监测插管期间病理生理变化的进展，并了解新生儿呼吸道的体内生长发育。我们相信，我们将能够建立OCT作为一种可行的诊断成像方式，可以用于监测新生儿的呼吸道，并诊断早期发病的SGS和其他ICU获得性喉部和上呼吸道疾病，这些疾病导致拔管失败并最终行气管切开术。

DESCRIPTION (provided by applicant): We seek to develop critical technology to help pre-mature infants and newborns in the first days of life survive and avoid serious airway complications that arise from subglottic stenosis (SGS), the most common acquired anomaly of the larynx in children and the most common abnormality requiring tracheotomy in infants. SGS is preventable and is caused by endotracheal intubation during the critical first days of life. In the premature infant and newborn, this condition may pass undetected or present as a life-threatening event. The ability to better treat and even prevent subglottic stenosis has improved with technical advances in neonatal intensive care, but diagnosis remains a source of continued controversy and debate. The tissues of the subglottis are delicate in nature, easily damaged, and rapidly develop edematous changes, and are predisposed to inflammation, scar formation, and stenosis. Surgical endoscopy has remained the gold standard in the diagnosis of SGS. Unfortunately, surgery requires general anesthesia and is limited to the characterization of the surface anatomy and does not provide detailed analysis of the sub-epithelial tissues. This clinical circumstance is often complicated as the pulmonary, cardiac, and hypoxic thresholds in the newborn population may postpone the evaluation of the airway due to limited tolerances to physiologic stress. In essence, the ultimate challenge in the evaluation of the newborn airway is to minimize diagnostic trauma and physiologic stress while accurately characterizing the laryngeal tissues. Optical Coherence Tomography (OCT) is an imaging modality that utilizes light to produce high-resolution images of living tissues with a resolution in excess of 10 5m. OCT allows for one to distinguish the epithelium from the underlying tissue microstructures based on tissue optical properties with real-time frame rates. Using OCT one can non-invasively characterize living tissues well beyond the current imaging capacities of MRI, CT and ultrasound. We propose to design and construct high speed, high resolution OCT technology combined with 3-D MEMs based probes to image the newborn and infant airways in the neonatal intensive care unit, and define the potential role of OCT in diagnosing the onset and progression of subglottic airway disease in these critically ill patients. First we will optimize the technology in a New Zealand white rabbit model of SGS and compare OCT with conventional microscopy. Then, we will image the subglottic airway in 200 intubated neonates at the UC Irvine-Children's of Hospital of Orange County ICUs and correlate morphologic and structural features obtained with OCT with physiologic and functional variables such as gestational age, weight, and number of failed extubations in order to identify variables that can be used to better predict successful airway extubation, monitor progression of pathophysiologic changes during intubation, and understand the in vivo growth and development of the neonatal airway. We believe we will be able to establish OCT as a viable diagnostic imaging modality that can be used to monitor the neonatal airway and diagnose the early the onset SGS and other ICU acquired laryngeal and upper airway diseases that lead to failed extubation and ultimately tracheostomy.