Day 3 neonate with acute onset of stridor

[drsanjujoseph]

Term AGA baby was noted to have mild stridor on D2 of life . On D3 baby developed acute worsening of stridor with desaturation. No h/o birth asphyxia, trauma, intubation CXR,CT Thorax and neck wnl. please discuss management . we dont have facility for laryngoscopy.

[Stefan Johansson]

I do not understand the history fully - is the baby intubated due to stridor?

Generally more severe stridor would probably be related to glottic airway obstruction such as vocal cord paralysis, some kind of malformation (web, hygroma, hemangioma etc). Laryngomalacia is probably the most common etiology of stridor among newborns.

Laryngoscopy would be great if you had access, but as you don't I believe a conservative approach is the best as long as the situation worsens with feeding difficulties, oxygen need etc.

[drsanjujoseph]

Sir, this baby had respiratory distress with stridor on D3 of life . baby was not intubated. baby had desaturation in room air . baby improved with a single dose of hydrocortisone and antibiotics started despite a normal sepsis screen. i would like to know practice guidelines for management of stridor in a neonate

[Guest ajaymenon]

Dear sanju,

Stridor means an obstruction in the large airway.if nothing is found outside the airway,looking for something inside the airway (vocal cords)is the usual dictum.look at the v.cord movements,structure and anatomy.note if you can visualise any haemangioma/swelling .An important point to remember is to look for s.calcium/phosphate, vitamin D levels

.Each day more and more reports about maternal vitamin D deficiency seems to be coming out.

Considering the baby has improved with hydrocortisone /antibiotics might suggest an inflammation.

Neonates with intracerebral bleed also presents with grunting, which sometimes can be confused with stridor.

Please keep us posted about the case .

[Stefan Johansson]

Here's a link to a good article online.

http://www.netsvic.org.au/nets/handbook/index.cfm?doc_id=912

If you don't have access to fiberoptic laryngoscopy and the baby is well (feeding, thriving), I advocate to just wait and see as the most common diagnosis of laryngomalacia resolves spontaneously over time.

If the baby is not well, then it is a more tricky question how to make further investigations. Visualization of the upper airway and soft tissues surrounding it is then probably needed.