Stridor in the Neonate

Abstract

Stridor in the neonate is a sign that necessitates a basic physiological approach to establish a diagnosis. This includes a detailed assessment of the characteristics of the stridor; its associated features particularly voice quality, swallow, cough as well as general features and finally the levels of respiratory distress. The differential diagnosis is wide ranging, the associated features are common and the associated distress is highly variable. Common disorders causing stridor in the neonate include laryngomalacia, tracheobronchomalacia disorders, subglottic stenosis, and cysts; while vocal cord immobility, clefts, webs, hemangiomas and masses are rare. Diagnostic laryngoscopy and bronchoscopy are required in many cases.Management ranges from observation and parental education in mild cases to relief of hypoxia, relief or removal of obstruction and treatment of the specific causes through surgical means in the severe and potentially dangerous. A specialized chronic illness teamwork approach including medical, paramedical, psychological support for the child and family and otolaryngological and surgical teams is often required to ensure a satisfactory outcome. OVERVIEWStridor is a respiratory noise attributed to turbulent gas flow and other physical factors in the larynx or tracheal areas. Stridor is more often inspiratory in timing but expiratory and biphasic stridor also occur. Stridor is a relatively common sign confronting pediatricians however when present in the neonate it often causes considerable concern and anxiety because of its association with upper airway obstruction, respiratory distress, the ensuing diagnostic possibilities and the logistics and risks involved in affirming the diagnosis and instituting effective management. While the consequences of stridor as a sign are well understood by pediatricians and otolaryngologists, actually recognizing stridor is not necessarily easy for the broader range of general health care professions and parents as both alike often overlook it, underestimate it, confuse it with stertor, wheeze and other respiratory noises [1]. This may lead to delays in diagnosis, significant morbidity and even mortality. Combinations of noises such as stridor and wheeze, or stridor and "rattle" are also relatively common and may be confusing, yet they may still indicate the presence of important lesions. As the differential diagnosis is wide ranging from self resolving disorders to those with potentially life-threatening consequences, allocating the patient's symptoms and signs to a meaningful management process with the appropriate experience is required to ensure a safe approach to care. APPROACH TO STRIDORPatient history, contextual factors and focused histories invariably set the scene for diagnostic accuracy in clinical medicine. This is particularly the case for stridor in the neonate as appropriate management strategies generally flow from this point in most cases.The basic first principle premises for the accurate diagnosis of airway obstruction are that lesions causing...