Stridor musical, monophonic, audible breath sounds (noisy breathing) caused by oscillations of narrowed large extrathoracic airways indicates a partial obstruction of the upper airways, glottis, or trachea
History CC : inspiratory stridor 1 day after birth PI : Maternal Hx. : 24 yr. G1P0A0 Antenartal Hx : Adequate ANC GA 40 wks by date C/S due to CPD
Term AGA female infant BW 3630 g (P75), HC 34 cm (P50), Lt 51 cm (P 50) Apgar 7 (color 2, RR1), 9 (RR1) O 2 tubing 5 LPM and tactile stimulation After birth RR 48/min 30 min after birth developed tachypnea and grunting Transfer to nursery
At nursery: physical examination V/S : T 37.6 C, P 163/min, BP 61/36 mmHg, RR 52/min Sp O 2 65% (RA) GA : Active, central and peripheral cyanosis, no jaundice, no hemangioma at beard and neck region HEENT : no midline defect, poor nasal air flow Rt. > Lt.
RS : Dyspnea, subcostal retraction, no flaring of alar nasi, no grunting, normal breath sounds, no adventitious sound, no stridor CVS : Normal S1,S2, no murmur Abdomen : WNL NS : Normotonia, symmetrical movement, grasping reflex +ve, rooting reflex +ve, Moro reflex +ve At nursery: physical examination
At nursery O 2 tubing 10 LPM and Syringe ball suction with NSS Nasal drop : improved Then continue O 2 hood 5 LPM : SpO 2 99 %, FiO 2 0.45 then wean off O 2 in 6 hrs later SpO 2 98%
Cyanosis 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.
Congenital Vocal cord paralysis Unilateral- stridor and retraction are not marked weak & hoarse cry, aggravated by agitation Feeding difficulties
Congenital Unilateral Vocal cord paralysis Etiology ousually idiopathic osecondary to peripheral n. esp. recurrent laryngeal n. -Lt.sided : common perhaps from birth trauma -Rt. Sided : complication of thoracic & neck surgery oMay be lesions in the mediastinum (tumors and vascular malformations) Prognosis – uncertain due to etiologies
Congenital Vocal cord paralysis Bilateral -much more serious condition stridor at rest near-normal phonation progressive airway obstruction poor prognosis due to underlying and associated problems
Management in this patient Specific No specific treatment for vocal cord paralysis Ix for underlying etiology Supportive Observe respiratory: apnea, SpO 2 Retain OG tube Correct position
Take home message Upper 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 stridor REFER