Stridor in the Neonate

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.