3Stridor musical, monophonic, audible breath sounds (noisy breathing) caused by oscillations of narrowed large extrathoracic airwaysindicates a partial obstruction of the upper airways, glottis, or trachea
4History CC : inspiratory stridor 1 day after birth PI : Maternal Hx. : 24 yr. G1P0A0Antenartal Hx : Adequate ANCGA 40 wks by dateC/S due to CPD
5Term AGA female infantBW 3630 g (P75), HC 34 cm (P50), Lt 51 cm (P 50)Apgar 7 (color 2, RR1), 9 (RR1)O2 tubing 5 LPM and tactile stimulationAfter birth RR 48/min30 min after birth developed tachypnea and gruntingTransfer to nursery
6At nursery: physical examination V/S : T 37.6 C, P 163/min, BP 61/36 mmHg, RR 52/minSp O2 65% (RA)GA : Active, central and peripheral cyanosis, no jaundice, no hemangioma at beard and neck regionHEENT : no midline defect, poor nasal airflow Rt. > Lt.
7At nursery: physical examination RS : Dyspnea, subcostal retraction,no flaring of alar nasi, no grunting, normal breath sounds, no adventitious sound,no stridorCVS : Normal S1,S2, no murmurAbdomen : WNLNS : Normotonia, symmetrical movement, grasping reflex +ve, rooting reflex +ve, Moro reflex +ve
8At nurseryO2 tubing 10 LPM and Syringe ball suction with NSS Nasal drop : improvedThen continue O2 hood 5 LPM :SpO2 99 %, FiO then wean off O2 in 6 hrs later SpO2 98%
9Cyanosis developed when she received spoon feeding and spontaneously recovered, then she was retained OG tube.Cyanosis and inspiratory stridor related with hoarse crying can be improved by prone position.
23Congenital Vocal cord paralysis Unilateral-stridor and retraction are not markedweak & hoarse cry, aggravated by agitationFeeding difficulties
24Congenital Unilateral Vocal cord paralysis Etiologyusually idiopathicsecondary to peripheral n. esp. recurrent laryngeal n.-Lt.sided : commonperhaps from birth trauma-Rt. Sided : complication of thoracic & neck surgeryMay be lesions in the mediastinum(tumors and vascular malformations)Prognosis – uncertain due to etiologies
25Congenital Vocal cord paralysis Bilateral -much more serious conditionstridor at restnear-normal phonationprogressive airway obstructionpoor prognosis due to underlying and associated problems
26Management in this patient SpecificNo specific treatment for vocal cord paralysisIx for underlying etiologySupportiveObserve respiratory: apnea, SpO2Retain OG tubeCorrect position
28Take home messageUpper airway obstruction can be cured as conservative but when the patient develop - cyanosis when feeding- weak cry- hoarseness of voice- abnormal lat. neck film- biphasic stridorREFER