Impact and workload implications on service provision with establishment of a neonatal complex airway service in Scotland.

The objective of this study was to assess if any changes have occurred in the utilization of neonatal services with referral for neonatal airway assessment and how this is related to the establishment of a National Complex Airway Service. A retrospective case-note review was performed for neonates referred for airway assessment from 2004-2010 inclusive. Seventy-nine neonates were referred from throughout Scotland; 10 in 2004-2006, 24 in 2007-2008 and 45 in 2009-2010. The mean gestational age was 35 weeks; 39% were preterm. Stridor was the most common reason for referral (46%). The most common diagnosis was airway malacia (38%). Fifty-three procedures were performed on the ward. In total, 64 microlaryngobronchoscopies were performed; 45 diagnostic and 19 interventional. The most common intervention was supraglottoplasty for airway malacia. Thirty-five separate airway procedures were undertaken. Additional investigations were frequently requested and co-morbidities were common. Since the establishment of the Scottish National Complex Airway Service in 2006, referrals for neonatal airway assessment have increased significantly. The reasons for this include a greater awareness of the service, improved treatment options and increased preterm survival. These neonates frequently have associated co-morbidities and require a repertoire of specialist input. This increase has significant implications for further service provision.