An Unusual Case of Stridor in Newborns: Understanding the Common Physical Finding

Introduction

Stridor, a common physical finding in newborns, refers to the harsh, high-pitched sound produced during respiration. It occurs due to turbulent airflow through a narrowed upper airway. In this article, we will delve into the causes, diagnosis, and treatment options for newborn stridor, with a particular focus on laryngomalacia, the most prevalent cause.

Understanding the Differential Diagnosis

When confronted with newborn stridor, healthcare professionals consider various potential causes. These include laryngomalacia, unilateral and bilateral vocal fold paralysis, laryngeal web, glottic stenosis, subglottic stenosis, and other airway-obstructing lesions. However, laryngomalacia accounts for a significant proportion, affecting approximately 45% to 75% of infants with congenital stridor.

Unraveling Laryngomalacia

Laryngomalacia remains the leading cause of stridor in newborns, characterized by an inspiratory sound that typically worsens during feeding, agitation, and when the infant is in a supine position. However, the stridor tends to decrease when the newborn is in a prone position. Associated symptoms related to feeding may include emesis, cough, and choking. Severe cases of laryngomalacia, although less common, can present with recurrent cyanosis, apneic pauses, and failure to thrive.

Etiology of Laryngomalacia

The exact etiology of laryngomalacia remains uncertain, but experts believe it to be a result of both anatomical (cartilaginous) and neurologic immaturity. The immature cartilage and soft tissues in the larynx are thought to collapse inward during inspiration, causing the characteristic stridor.

A Clinical Case and Diagnostic Findings

To illustrate the presentation and diagnosis of severe laryngomalacia, a case involving a late-preterm neonate was examined. The neonate, born at 36 weeks and 5 days, exhibited stridor immediately after birth. The delivery was induced due to intrauterine growth restriction, and no complications were reported. Physical examination findings included a birth weight below the 10th percentile, moderate to severe work of breathing (suprasternal and subcostal retractions), and inspiratory stridor that worsened in the supine position and during crying.

Endoscopic nasolaryngoscopy, a diagnostic procedure, revealed an omega-shaped epiglottis and collapse of the supraglottic tissues during inspiration. Additionally, the right arytenoid cartilage was found to be anteromedially displaced. However, visualization of the vocal folds was inadequate for assessing their movement. These findings led to a presumptive diagnosis of severe laryngomalacia. Subsequently, the patient developed a right Horner syndrome, prompting further imaging of the head, neck, and upper chest. This ultimately resulted in the identification of an unusual cause of stridor in the newborn.

Conclusion

In conclusion, stridor is a common physical finding in newborns caused by turbulent airflow through a narrowed upper airway. Laryngomalacia, with its inspiratory stridor and associated symptoms, represents the most prevalent cause of newborn stridor. By understanding the differential diagnosis, etiology, and diagnostic findings of laryngomalacia, we can better educate and inform both healthcare professionals and concerned parents. Crafting high-quality content, such as this article, is a crucial step towards outranking other websites and establishing authority in the field.

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Paediatrics & Child Health, 2022, 27, 321–323 htps://doi.org/10.1093/pch/pxac063 Clinician’s Corner

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