ABSTRACT
The list in Box 33.1 is not exhaustive but does provide the main indications. The commonest causes of stridor and airway obstruction in a neonate are: (1) laryngomalacia (2) subglottic stenosis, congenital and acquired, and (3)
vocal cord paralysis, unilateral and bilateral. Rarer causes include laryngeal clefts, hemangiomas and papillomas. Rigid bronchoscopy is the diagnostic procedure of choice in the management of airway obstruction. Neonates with stridor can be subdivided into three main groups. In the first group is the neonate with severe stridor and significant airway obstruction, who will require urgent bronchoscopy and airway support. Secondly a neonate with worsening airway obstruction is another indication for bronchoscopy. Thirdly mild or moderate stridor with poor weight gain or difficulty in feeding, apnea or cyanosis would also be an indication for endoscopy. Radiological investigations often raise the suspicion of a diagnosis, e.g. a vascular ring on barium swallow. Endoscopy is needed to confirm this diagnosis. In neonates with recurrent aspiration rigid bronchoscopy is necessary to rule out a laryngotracheal cleft. A complete systematic assessment is necessary as about 70% of bronchoscoped neonates have more than one pathology.4
