Neonate & infant airway pathologies

Noisy breathing or stridor in a neonate or an infant is a warning sign of a pathology involving his airway that can extend from the nostrils upto the lungs. These conditions should be taken seriously and treated with utmost urgency. Time is of great importance, as critically airway distressed child can lead to many complications, including death. These conditions can be acute or chronic in origin. Acute onset can be due to infective pathologies, trauma or foreign bodies.

Symptoms of an airway problem consists of stridor, chest retractions, abnormal cry, apnea, cyanosis (blue spells) and feeding difficulties.

Various causes of respiratory problems range from nasal blockage (choanal atresia, large adenoids), oropharyngeal obstruction (hypertrophic tonsils, large base tongue, lymphatic and vascular malformations, mandibular problems), laryngeal stenosis (glottic and subglottic stenosis) and tracheal stenosis (tracheomalacia, tracheal stenosis and complete tracheal rings). Bilateral choanal atresia may cause severe airway obstruction and may be life threatening. Laryngomalacia is the commonest cause for inspiratory stridor in babies and in majority of cases, it improves with age, without needing a surgery.

Preterm babies might need to be intubated at birth due to airway, cardiopulmonary or neurological problems and this can be a major cause for laryngeal stenosis. Sometimes, due to underlaying pathologies or prolonged intubation, the doctor may decide to do a tracheostomy (neck tube/canula), which needs special care and management.

The tracheostomy remains permanent in patients with severe neurological and cardio-respiratory problems. Decannulation (removing the tracheotomy canula) is achieved in patients after definite airway reconstructive procedures. Our team has more than 90 % decannulation rates in both infants and children (Ref. Pediatric Airway Surgery, Springer Ed. Philippe Monnier).