Neonatal and Infant Airway Disorders

Infant stridor: Assess airway patency, ventilation, feeding and growth. Congenital lesions may coexist at several levels; laryngomalacia does not exclude a synchronous lesion.

Stridor with recession, poor feeding, apnoea or cyanosis requires joint assessment with paediatric anaesthesia and the neonatal or paediatric team; deterioration requires immediate airway support and critical care.

Laryngomalacia usually improves with growth; hypoxaemia, obstructive episodes, aspiration or faltering growth change management. Stridor volume does not measure severity.

Localisation: Inspiratory supraglottic collapse supports laryngomalacia; respiratory phase localises the level only approximately, and synchronous lesions can occur elsewhere in the airway.

Severity of obstruction: Feeding failure, faltering growth, apnoea, cyanosis or impaired gas exchange determine management, even in an infant comfortable between episodes; an omega-shaped epiglottis alone does not justify surgery.

Endoscopic assessment: Awake flexible endoscopy shows dynamic supraglottic collapse and vocal-fold movement; MLB examines the whole airway and can reveal a posterior cleft hidden by redundant mucosa.

Vocal-fold immobility: A weak cry with aspiration after cardiac surgery suggests unilateral palsy; bilateral immobility can cause major obstruction with a relatively preserved cry.

Laryngomalacia and reflux: Assess feeding and swallowing. Routine acid suppression showed no added benefit in a small trial of mild to moderate disease without significant reflux; prescribe only for a separate reflux indication.

Supraglottoplasty: Tailor the procedure to the type of collapse and preserve interarytenoid mucosa, because opposing raw surfaces scar and narrow the supraglottis.