Differential diagnosis of stridor in the newborn: Guidelines for a time-efficient and cost-effective evaluation

David E. Tunkel, Melissa Ortiz

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Stridor is an abnormal respiratory noise that usually indicates the presence of a fixed and/or dynamic obstruction of the upper airway. Stridor in a neonate is particularly concerning because it may indicate a severe lesion that can compromise airway patency in an infant with little tolerance for impaired ventilation or oxygenation. We will discuss the differential diagnosis of stridor in neonates using a time and cost-efficient strategy for evaluation. We will discuss the diagnostic tests that are most appropriate for neonates with noisy breathing by emphasizing the use of physical examination and history to determine the location(s) of the airway obstruction(s) and to narrow the differential diagnosis. A focused history centers on perinatal issues and the onset and progression of stridor. We will discuss the relevant associated signs and symptoms, as well as the changes in stridor while an infant is awake, feeding, or sleeping. We will address the most appropriate use of airway endoscopy in the ambulatory setting and in the operating room. Fiberoptic laryngoscopy in awake neonates is perhaps the most useful endeavor for evaluating newborn infants who have stridor. Radiologic tests will be discussed, with a renewed focus on reducing exposure to ionizing radiation by selecting the correct imaging modality and avoiding studies that are not useful.

Original languageEnglish (US)
Title of host publicationDisorders of the Neonatal Airway
Subtitle of host publicationFundamentals for Practice
PublisherSpringer New York
Pages189-200
Number of pages12
ISBN (Electronic)9781493916108
ISBN (Print)9781493916092
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Airway fluoroscopy
  • Direct laryngoscopy and bronchoscopy
  • Fiberoptic laryngoscopy
  • Laryngomalacia
  • Larynx
  • Stridor
  • Subglottic stenosis
  • Trachea
  • Vocal cord paralysis

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Differential diagnosis of stridor in the newborn: Guidelines for a time-efficient and cost-effective evaluation'. Together they form a unique fingerprint.

  • Cite this

    Tunkel, D. E., & Ortiz, M. (2015). Differential diagnosis of stridor in the newborn: Guidelines for a time-efficient and cost-effective evaluation. In Disorders of the Neonatal Airway: Fundamentals for Practice (pp. 189-200). Springer New York. https://doi.org/10.1007/978-1-4939-1610-8_19