When Innovation Meets Affordability: The NIJU (Non-balloon Intra-luminal Judicious Upsizing) Technique for Acquired Subglottic Stenosis in Neonates and Infants—A Case Series

Abstract

Acquired subglottic stenosis (SGS) remains a significant complication of pediatric endotracheal intubation, with hindered management in low-resource settings. Here, we describe the feasible use of the NIJU (Non-balloon Intra-luminal Judicious Upsizing) technique, utilizing low-cost, readily available materials as an alternative to balloon dilatators in the management of acquired simple membranous SGS in three infants. They underwent endoscopic evaluation and intervention using the NIJU protocol after airway securement and stabilization. Outcomes were assessed via check bronchoscopy, imaging, and clinical follow-ups. All three infants demonstrated marked symptomatic, bronchoscopic, and imaging improvement with no intraoperative or postoperative complications. None required repeat intervention, and there was no recurrence of stenosis on follow-ups. The cost of the procedure was reduced approximately 10-fold compared with conventional methods, thereby highlighting the feasibility of groundbreaking, low-cost techniques for endoscopic management of simple membranous SGS of lower grades in early life.