DOCSLIB.ORG

Congenital Airway Abnormalities in Patients Requiring Hospitalization

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Congenital Airway Abnormalities in Patients Requiring Hospitalization ORIGINAL ARTICLE Congenital Airway Abnormalities in Patients Requiring Hospitalization Ken W. Altman, MD, PhD; Ralph F. Wetmore, MD; Roger R. Marsh, PhD Objective: To determine the cause of congenital air- logical findings and/or clinical evaluation. Sixty-five pa- way abnormalities in pediatric patients requiring hospi- tients (37%) had multiple sites of airway abnormalities; talization for their respiratory status. laryngeal abnormalities were noted almost 3 times as of- ten as tracheal abnormalities (161 vs 62, respectively). Design and Setting: Case series in a tertiary care Of the laryngeal abnormalities, laryngomalacia was the center. most common, followed by glottic web, subglottic ste- nosis, vocal-cord paralysis, and subglottic heman- Patients: A 5-year retrospective chart review was con- gioma. Tracheomalacia was the most common tracheal ducted at our institution. A total of 174 patients were iden- abnormality, followed by external compression and tra- tified who required hospitalization for their respiratory cheal stenosis. Thirty-three patients (19%) required tra- status as a result of a congenital airway abnormality. cheotomy for management of recurrent respiratory de- compensation. Results: Of the 174 patients, 114 (65.5%) were male and 60 (34.5%) were female. Eighty patients (47%) pre- Conclusions: While congenital airway abnormalities are sented within the first 3 months of life. Forty-six pa- usually self-limited, those patients requiring hospitaliza- tients (26%) were born prematurely, and 49 patients tion represent a group with a more severe respiratory sta- (28%) were diagnosed as having gastroesophageal re- tus who have a greater chance of requiring trache- flux. The majority of patients (139 [80%]) had multiple otomy. The recognizable percentage of patients with presenting symptoms or signs. Stridor was the most com- gastroesophageal reflux and prematurity accounts for co- mon (129 [74%]), followed by accessory respiratory ef- morbid factors in the need for hospitalization for respi- fort, cyanosis, apnea, and failure to thrive. Diagnosis was ratory issues related to congenital airway abnormalities. made at the time of surgical evaluation in 91% of the pa- tients, with the remaining diagnoses made using radio- Arch Otolaryngol Head Neck Surg. 1999;125:525-528 ONGENITAL AIRWAY abnor- RESULTS malities in the pediatric population are usually A total of 174 patients were identified who mild in severity, often required hospitalization for their respira- presenting with stridor tory status as a result of a congenital air- C(noisy breathing from obstructed air- way abnormality. One hundred fourteen flow) or stertor (snorting or gurgling patients (65.5%) were male, and 60 pa- from obstruction in the nose or phar- tients (34.5%), female. Seventy-three pa- ynx). However, exacerbation of symp- tients (42%) required endotracheal intu- toms with compromise of respiratory sta- bation prior to the time of diagnosis of a tus may become evident in patients with congenital airway abnormality, with a comorbid medical conditions, multiple mean duration of 22 days and a median sites of airway abnormalities (synchro- duration of 2 weeks. The age distribution nous lesions), and during upper respira- at the time of diagnosis is shown in tory tract infections. The purpose of this Figure 1, with a mean age of 7.6 months study is to determine the cause of con- and a median age of 3.2 months. Of the From the Department of Otolaryngology, Children’s genital airway abnormalities in pediatric 174 patients, 82 (47%) were diagnosed at Hospital of Philadelphia and patients requiring hospitalization for 3 months or younger. the University of Pennsylvania their respiratory status, with attention to Prematurity (#36 weeks’ estimated School of Medicine, prematurity, comorbid medical condi- gestational age at birth) was identified in Philadelphia. tions, and outcome. 46 patients (26%). Major cardiovascular, ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 125, MAY 1999 525 ©1999 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 25 PATIENTS, MATERIALS, AND METHODS 20 15 A retrospective chart review was conducted in all pa- tients treated at the Children’s Hospital of Philadel- phia, Philadelphia, Pa, with congenital airway abnor- Patients, % 10 malities requiring hospitalization between July 1, 1991, and June 30, 1996. Patients were selected if their di- 5 agnoses were categorized from the following Interna- tional Classification of Diseases, Ninth Revision1 diag- nostic codes: 748.2 (laryngeal web), 748.3 (congenital 0 1 2 3 4 5 6 7 8 9 10 11 12 >12 anomalies of the larynx, trachea, and bronchus), and Age, mo 478.30 to 478.34 (vocal-cord or vocal-fold paraly- sis). Patients with the following anomalies that were Figure 1. Age distribution of patients at the time of diagnosis. Note that 47% presented at 3 months or younger, and 67% presented at 6 months or presumed to be acquired were excluded: subglottic ste- younger. nosis, tracheomalacia or bronchomalacia as a sole find- ing in patients who had received ventilation through an endotracheal tube for longer than 6 days, and vocal-fold paralysis in newborn patients without Cardiovascular central nervous system findings. Medical records were reviewed for patient demographics, clinical Chromosomal presentation, comorbid medical conditions, diagnos- tic evaluation, treatment, and outcome. Patients whose medical records had incomplete documenta- Neurologic tion in these areas were also excluded. Congenital neurologic, chromosomal abnormalities, and/or congeni- None tal syndromes were present in 34 patients (19.5%; 0 20 40 60 80 Figure 2). Five patients had multiple major abnormali- Patients, % ties. Cardiovascular abnormalities were present in 25 pa- tients and included tetralogy of Fallot, abnormalities of Figure 2. Major comorbid medical abnormalities. the aortic arch, transposition of the great vessels, severe atrial or ventricular septal defect, and pulmonary artery and valvular deformity. Three patients had congenital Stridor syndromes, and 7 had chromosomal abnormalities in- Accessory cluding Down syndrome. Neurologic abnormalities Respiration were present in 4 patients and included spina bifida, mi- crocephalus, communicating hydrocephalus, and cere- Cyanosis bral palsy. Seventy-two patients (41%) had 1 or more of Apnea the above malformations and/or were born prema- turely. Gastroesophageal reflux was identified in 49 pa- Failure to tients (28%). Thrive Stridor was the most common presenting symp- Other tom or sign, found in 128 patients (74%) as shown in Figure 3. This was followed by accessory respiratory 0 20 40 60 80 100 effort in 71 patients (41%), cyanosis in 45 (26%), apnea Patients, % in 43 (25%), failure to thrive in 39 (22%), and cough in Figure 3. Symptoms and diagnoses of patients at presentation. “Other” 30 (17%). One hundred forty patients (80%) had mul- includes cough, oxygen desaturation and/or bradycardia while being tiple presenting symptoms or signs. Other presenting com- monitored, tachypnea, poor pulmonary toilet, weak cry, upper respiratory tract infection, asthma or wheezing, and restless sleep. plaints included oxygen desaturation and/or bradycar- dia while being monitored, tachypnea, poor pulmonary toilet, weak cry, upper respiratory tract infection, asthma Sixty-five patients (37%) were found to have mul- or wheezing, and restless sleep. tiple sites of airway abnormalities. There were a total of A diagnosis was made during surgery in 158 pa- 257 diagnostic findings, with laryngeal abnormalities tients (91%). Direct laryngoscopy was performed in 111 noted almost 3 times as often as tracheal abnormalities (64%), flexible laryngobronchoscopy in 117 (67%), and (161 vs 62). Overall, 154 patients (86%) had laryngeal rigid bronchoscopy in 54 (31%). The remaining pa- abnormalities, 60 patients (34%) had tracheal abnor- tients were diagnosed clinically or via radiographic evalu- malities, 18 patients (10%) had bronchial abnormalities ation with airway fluoroscopy and/or barium swallow. (all bronchomalacia except 1 with bronchial stenosis), ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 125, MAY 1999 526 ©1999 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 and 17 patients (10%) had upper airway obstruction (glos- soptosis, pharyngeal collapse, micrognathia, and choa- Prevalence of Tracheotomy and Endotracheal nal atresia). Intubation Prior to Diagnosis* Laryngeal anomalies are listed below. No. (%) of Patients Abnormality No. (%) of Patients Laryngomalacia 119 (68.4) Abnormality Tracheotomy Endotracheal Intubation Glottic web 15 (8.6) Subglottic hemangioma 2 (100) 0 (0) Subglottic stenosis 12 (6.9) External compression 6 (60)† 4 (40) Vocal-fold paralysis 8 (4.6) Subglottic stenosis 7 (58)† 9 (75)‡ Glottic or subglottic cyst 3 (1.7) Glottic stenosis 1 (50) 0 (0) Subglottic hemangioma 2 (1.1) Glottic web 6 (40) 10 (67)‡ Laryngeal stenosis or atresia 2 (1.1) Vocal-fold paralysis 2 (25) 3 (38) Tracheal anomalies are listed below. Tracheomalacia 14 (33)† 21 (50) Glottic or subglottic cyst 1 (33) 1 (33) Abnormality No. (%) of Patients Bronchomalacia or stenosis 5 (28) 12 (67)‡ Tracheomalacia 42 (24.1) Upper airway obstruction 3 (18) 4 (24) External compression 10 (5.7) Laryngomalacia 15 (13) 47 (39) Tracheal stenosis 5 (2.9) Transesophageal fistula 0 (0) 3 (100) Tracheoesophageal fistula 3 (1.7) Tracheal web 0 (0) 1 (100) Tracheal web 1 (0.6) Tracheal stenosis 0 (0) 2 (40) Tracheal
Load more

Recommended publications
  • Current Management and Outcome of Tracheobronchial Malacia and Stenosis Presenting to the Paediatric Intensive Care Unit
    Intensive Care Med 52001) 27: 722±729 DOI 10.1007/s001340000822 NEONATAL AND PEDIATRIC INTENSIVE CARE David P.Inwald Current management and outcome Derek Roebuck Martin J.Elliott of tracheobronchial malacia and stenosis Quen Mok presenting to the paediatric intensive care unit Abstract Objective: To identify fac- but was not related to any other fac- Received: 10 July 2000 Final Revision received: 14 Oktober 2000 tors associated with mortality and tor. Patients with stenosis required a Accepted: 24 October 2000 prolonged ventilatory requirements significantly longer period of venti- Published online: 16 February 2001 in patients admitted to our paediat- latory support 5median length of Springer-Verlag 2001 ric intensive care unit 5PICU) with ventilation 59 days) than patients tracheobronchial malacia and with malacia 539 days). stenosis diagnosed by dynamic con- Conclusions: Length of ventilation Dr Inwald was supported by the Medical Research Council. This work was jointly trast bronchograms. and bronchographic diagnosis did undertaken in Great Ormond Street Hos- Design: Retrospective review. not predict survival. The only factor pital for Children NHSTrust, which re- Setting: Tertiary paediatric intensive found to contribute significantly to ceived a proportion of its funding from the care unit. mortality was the presence of com- NHSExecutive; the views expressed in this Patients: Forty-eight cases admitted plex cardiac and/or syndromic pa- publication are those of the authors and not to our PICU over a 5-year period in thology. However, patients with necessarily those of the NHSexecutive. whom a diagnosis of tracheobron- stenosis required longer ventilatory chial malacia or stenosis was made support than patients with malacia.
    [Show full text]
  • The Role of Larygotracheal Reconstruction in the Management of Recurrent Croup in Patients with Subglottic Stenosis
    International Journal of Pediatric Otorhinolaryngology 82 (2016) 78–80 Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology jo urnal homepage: www.elsevier.com/locate/ijporl The role of larygotracheal reconstruction in the management of recurrent croup in patients with subglottic stenosis a,b,c, a,b a,d,e Bianca Siegel *, Prasad Thottam , Deepak Mehta a Department of Pediatric Otolaryngology, Childrens Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA b Children’s Hospital of Michigan, Detroit, MI, USA c Wayne State University School of Medicine Department of Otolaryngology, Detroit, MI, USA d Texas Children’s Hospital, Houston, TX, USA e Baylor University School of Medicine Department of Otolaryngology, Houston, TX, USA A R T I C L E I N F O A B S T R A C T Article history: Objectives: To determine the role of laryngotracheal reconstruction for recurrent croup and evaluate Received 16 October 2015 surgical outcomes in this cohort of patients. Received in revised form 4 January 2016 Methods: Retrospective chart review at a tertiary care pediatric hospital. Accepted 6 January 2016 Results: Six patients who underwent laryngotracheal reconstruction (LTR) for recurrent croup with Available online 13 January 2016 underlying subglottic stenosis were identified through a search of our IRB-approved airway database. At the time of diagnostic bronchoscopy, all 6 patients had grade 2 subglottic stenosis. All patients were Keywords: treated for reflux and underwent esophageal biopsies at the time of diagnostic bronchoscopy; 1 patient Laryngotracheal reconstruction had eosinophilic esophagitis which was treated. All patients had a history of at least 3 episodes of croup Recurrent croup in a 1 year period requiring multiple hospital admissions.
    [Show full text]
  • 1 British Thoracic Society Guidelines Recommendations for The
    Thorax Online First, published on September 28, 2007 as 10.1136/thx.2007.077370 Thorax: first published as 10.1136/thx.2007.077370 on 28 September 2007. Downloaded from British Thoracic Society Guidelines Recommendations for the assessment and management of cough in children MD Shields, A Bush, ML Everard, S McKenzie and R Primhak on behalf of the British Thoracic Society Cough Guideline Group Michael D Shields Dept. of Child Health, Queen’s University of Belfast, Clinical Institute, Grosvenor Road, Belfast, BT12 6BJ Email: [email protected] Andrew Bush Royal Brompton Hospital, Sydney Street, London, SW3 6NP Email: [email protected] Mark L Everard Dept of Paediatrics, Sheffield Children’s Hospital, Western Bank, Sheffield, S. Yorkshire, S10 2TH. Email: [email protected] Sheila McKenzie Queen Elizabeth Children’s Services, http://thorax.bmj.com/ The Royal London Hospital, Whitechapel, London, E1 1BB Email: [email protected] Robert Primhak Dept. of Paediatrics, Sheffield Children’s Hospital, on September 29, 2021 by guest. Protected copyright. Western Bank, Sheffield, S. Yorkshire, S10 2TH. Email: [email protected] “the Corresponding Author (Michael D Shields) has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd and its Licensees to permit this article (if accepted) to be published in [THORAX] editions and any other BMJPG Ltd products to exploit all subsidiary rights, as set out in our licence 1 Copyright Article author (or their employer) 2007.
    [Show full text]
  • Diagnostic Issues in Systemic Lupus Erythematosis
    266 Postgrad Med J 2001;77:266–285 Postgrad Med J: first published as 10.1136/pmj.77.906.268 on 1 April 2001. Downloaded from SELF ASSESSMENT QUESTIONS Diagnostic issues in systemic lupus erythematosis N Sofat, C Higgens Answers on p 274. A 24 year old woman was diagnosed with sys- (4) What other tests (apart from 24 hour urine temic lupus erythematosis (SLE) based on a creatinine clearance) are available to measure few months’ history of a photosensitive skin the glomerular filtration rate? rash, predominantly on her face, arthralgia The patient had a 24 hour urinary protein col- involving both hands and wrists, a positive lection, which showed a 24 hour protein measure- antinuclear antibody (ANA) test and a raised ment of 1.8 g. There was no evidence of cellular antinative double stranded DNA antibody casts on urine microscopy. Her blood results were binding level. She was treated with oral as below (normal values are in parentheses): hydroxychloroquine 400 mg daily and short x Sodium 134 mmol/l (135–145) courses of prednisolone during flare-ups. x Potassium 4.5 mmol/l (3.5–5.0) She was reviewed in clinic for her regular x Urea 7.0 mmol/l (2.5–6.7) follow up appointment when she was found to x Creatinine 173 µmol/l (70–115) be hypertensive on repeated measurements of x Haemoglobin 108 g/l (115–160) her blood pressure, an average value being x White cell count 4.5 × 109/l (4.0–11.0) 150/90 mm Hg. She was also urine dipstick x Platelets 130 × 109/l (150–400) positive for blood and protein.
    [Show full text]
  • Left Bronchial with Bronchomalacia, Intractable Wheeze
    Thorax 1991;46:459-461 459 heart disease.7 This report describes a boy Left bronchial who had had intractable wheezing from infancy as a result of widespread discrete areas isomerism associated of bronchomalacia without bronchiectasis, Thorax: first published as 10.1136/thx.46.6.459 on 1 June 1991. Downloaded from and who also had some minor congenital with bronchomalacia, malformations and a rare combination of bronchial, atrial, and abdominal anatomical presenting with arrangements. We report this case because of the unusual anatomy and other congenital intractable wheeze malformations, and to emphasise the care needed in assessing wheezy children. Philip Lee, Andrew Bush, John 0 Warner Case report This 12 year old boy was referred as a case of steroid resistant asthma. He had had recurrent episodes of coughing and noisy breathing from the age of 5 months, usually precipitated by an upper respiratory infection. At 22 months a Abstract murmur was noted during an episode of right The cause of the Williams Campbell syn- lower lobe pneumonia, and he subsequently drome (bronchomalacia with bronchi- underwent ligation ofa patent arterial duct. He ectasis) is controversial. A boy with subsequently developed wheezing in the early bronchomalacia, bifid ribs, and left bron- morning, a chronic cough, and breathlessness chial isomerism presented with intract- on minimal exertion, despite inhaling sal- able wheeze mimicking asthma. The butamol and beclomethasone. A trial of oral combination of the abdominal, bron- prednisolone, 30 mg daily for one week, failed chial, and atrial anatomy seen in this to improve his symptoms. The only physical child has been described only once finding of note was widespread inspiratory and previously.
    [Show full text]
  • Complications of Different Ventilation Strategies in Endoscopic Laryngeal
    Anesthesiology 2006; 104:52–9 © 2005 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Complications of Different Ventilation Strategies in Endoscopic Laryngeal Surgery A 10-year Review Yves Jaquet, M.D.,* Philippe Monnier, M.D.,† Guy Van Melle, M.D., Ph.D.,‡ Patrick Ravussin, M.D.,§ Donat R. Spahn, M.D., F.R.C.A.,࿣ Madeleine Chollet-Rivier, M.D.# Background: Spontaneous ventilation, mechanical controlled tracheal tube offers adequate airway protection and ventilation, apneic intermittent ventilation, and jet ventilation gas exchange, but the endotracheal tube prevents are commonly used during interventional suspension micro- optimal vision and access to the larynx. Furthermore, laryngoscopy. The aim of this study was to investigate specific 1–4 complications of each technique, with special emphasis on endotracheal fire may still be encountered with transtracheal and transglottal jet ventilation. the use of carbon dioxide laser despite the develop- Methods: The authors performed a retrospective single-insti- ment of nonflammable endotracheal tubes.5–7 tution analysis of a case series of 1,093 microlaryngoscopies 2. Spontaneous ventilation offers a free access to the performed in 661 patients between January 1994 and January larynx, but with a moving surgical field and a risk of 2004. Data were collected from two separate prospective data- bases. Feasibility and complications encountered with each inhalation of anesthetic gases and laser fumes by the technique of ventilation were analyzed as main outcome mea- patient
    [Show full text]
  • Diagnosis and Therapy for Airway Obstruction in Children with Down Syndrome
    ORIGINAL ARTICLE Diagnosis and Therapy for Airway Obstruction in Children With Down Syndrome Ron B. Mitchell, MD; Ellen Call, MS, CFNP; James Kelly, PhD Objectives: To document the causes of upper airway children had subglottic stenosis. Laryngomalacia was the obstruction in a population of children with Down syn- primary diagnosis in 10 children (43%), 8 of whom were drome and to highlight the role of associated comorbidi- younger than 1 month. Obstructive sleep apnea was the ties. primary diagnosis in 11 children (48%), 8 of whom were older than 2 years. All children with obstructive sleep ap- Design and Setting: Review of 23 cases involving chil- nea and 4 children with laryngomalacia had a second- dren with Down syndrome who were referred for upper ary ear, nose, and throat disorder. Gastroesophageal re- airway obstruction over a 21⁄2-year period to the Pediat- flux was a comorbidity in 14 children (61%). ric Otolaryngology Service of the University of New Mexico, Albuquerque. Conclusions: The causes, severity, and presentation of upper airway obstruction in children with Down syn- Methods: Data on the following variables were ob- drome are related to the age of the child and to associ- tained: reason for referral, demographics, diagnosis, sur- ated comorbidities. The treatment of comorbidities and gical procedures, complications, and comorbidities. secondary ear, nose, and throat disorders is an integral component of the surgical management of upper airway Results: The children ranged in age from 1 day to 10.2 obstruction in such cases. years (mean age, 1.8 years; median age, 6 months). Thir- teen children were male and 10 were female.
    [Show full text]
  • Subglottic Stenosis: Current10.5005/Jp-Journals-10001-1272 Concepts and Recent Advances Review Article
    IJHNS Subglottic Stenosis: Current10.5005/jp-journals-10001-1272 Concepts and Recent Advances REVIEW ARTICLE Subglottic Stenosis: Current Concepts and Recent Advances 1Oshri Wasserzug, 2Ari DeRowe ABSTRACT Signs and Symptoms Subglottic stenosis is considered one of the most complex and The symptoms of SGS in children are closely related to challenging aspects of pediatric otolaryngology, with the most the degree of airway narrowing. Grade I SGS is usually common etiology being prolonged endotracheal intubation. The asymptomatic until an upper respiratory tract infection surgical treatment of SGS can be either endoscopic or open, but recent advances have pushed the limits of the endoscopic occurs, when respiratory distress and stridor, which are approach so that in practice an open laryngotracheal surgical the hallmarks of SGS, appear. Grades II and III stenosis approach is considered only after failed attempts with an can cause biphasic stridor, air hunger, dyspnea, and endoscopic approach. In this review we discuss these advances, suprasternal, intercostal, and diaphragmatic retractions. along with current concepts regarding the diagnosis and Prolonged or recurrent episodes of croup should raise treatment of subglottic stenosis in children. suspicion for SGS. Keywords: Direct laryngoscopy, Endoscopic surgery, Laryngo- At times, the appearance of SGS may be insidious and tracheal surgery, Prolonged intubation, Subglottic stenosis. progressive. It is important to recognize that a compro- How to cite this article: Wasserzug O, DeRowe A. Subglottic Stenosis: Current Concepts and Recent Advances. Int J Head mised airway in a child can lead to rapid deterioration Neck Surg 2016;7(2):97-103. and require immediate appropriate intervention to avoid Source of support: Nil a catastrophic outcome.
    [Show full text]
  • Revision Tracheobronchoplasty: Case Report
    4 Case Report Page 1 of 4 Revision tracheobronchoplasty: case report Ammara A. Watkins, Jennifer L. Wilson, Mihir Parikh, Adnan Majid, Sidhu P. Gangadharan Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess, Harvard Medical School, Boston, MA, USA Correspondence to: Sidhu P. Gangadharan, MD. Chief, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd. W/DC 201 Boston, MA 02215, USA. Email: [email protected]. Abstract: Tracheobronchoplasty, or posterior splinting of the airway with mesh, is a durable solution for patients with severe tracheobronchomalacia (TBM). Recurrent symptoms of TBM following tracheobronchoplasty are uncommon; however, when they occur can have significant impact on quality of life. Appropriate management of recurrent TBM requires a systematic and multidisciplinary collaborative approach. We present a patient with postoperative symptom recurrence requiring revisional tracheobronchoplasty to highlight the complexity of the disease’s presentation, workup and treatment. Keywords: Reoperative; revision; tracheobronchoplasty; tracheobronchomalacia (TBM); case report Received: 06 October 2019; Accepted: 18 December 2019; Published: 25 November 2020. doi: 10.21037/ccts.2019.12.14 View this article at: http://dx.doi.org/10.21037/ccts.2019.12.14 Introduction her tracheobronchoplasty she reported recurrent wheezing, cough and shortness of breath. By four years following Tracheobronchomalacia is an increasingly recognized her operation, the progressive symptoms considerably abnormality of the central airway that can cause dyspnea, impacted her quality of life. She was unable to walk 2 cough, recurrent respiratory infections and respiratory blocks without shortness of breath and had been admitted insufficiency (1,2). The hallmark of the disease is expiratory at least six times in the past year due to respiratory distress.
    [Show full text]
  • [Intrinsic] Tracheomalacia in Children
    Interventions for primary (intrinsic) tracheomalacia in children (Review) Masters IB, Chang AB This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2005, Issue 4 http://www.thecochranelibrary.com Interventions for primary (intrinsic) tracheomalacia in children (Review) Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 5 DISCUSSION ..................................... 5 AUTHORS’CONCLUSIONS . 6 ACKNOWLEDGEMENTS . 6 REFERENCES ..................................... 6 CHARACTERISTICSOFSTUDIES . 7 DATAANDANALYSES. 9 ADDITIONALTABLES. 9 WHAT’SNEW..................................... 9 HISTORY....................................... 10 CONTRIBUTIONSOFAUTHORS . 10 DECLARATIONSOFINTEREST . 10 SOURCESOFSUPPORT . 10 INDEXTERMS .................................... 10 Interventions for primary (intrinsic) tracheomalacia in children (Review) i Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Interventions for primary (intrinsic) tracheomalacia in children I Brent Masters1, Anne B Chang2 1Respiratory Medicine, Royal Children’s Hospital, Brisbane, Australia.
    [Show full text]
  • Supraglottoplasty Home Care Instructions Hospital Stay Most Children Stay Overnight in the Hospital for at Least One Night
    10914 Hefner Pointe Drive, Suite 200 Oklahoma City, OK 73120 Phone: 405.608.8833 Fax: 405.608.8818 Supraglottoplasty Home Care Instructions Hospital Stay Most children stay overnight in the hospital for at least one night. Bleeding There is typically very little to no bleeding associated with this procedure. Though very unlikely to happen, if your child were to spit or cough up blood you should contact your physician immediately. Diet After surgery your child will be able to eat the foods or formula that they usually do. It is important after surgery to encourage your child to drink fluids and remain hydrated. Daily fluid needs are listed below: • Age 0-2 years: 16 ounces per day • Age 2-4 years: 24 ounces per day • Age 4 and older: 32 ounces per day It is our experience that most children experience a significant improvement in eating after this procedure. However, we have found about that approximately 4% of otherwise healthy infants may experience a transient onset of coughing or choking with feeding after surgery. In our experience these symptoms resolve over 1-2 months after surgery. We have also found that infants who have other illnesses (such as syndromes, prematurity, heart trouble, or other congenital abnormalities) have a greater risk of experiencing swallowing difficulties after a supraglottoplasty (this number can be as high as 20%). In time the child usually will return to normal swallowing but there is a small risk of feeding difficulties. You will be given a prescription before you leave the hospital for an acid reducing (anti-reflux) medication that must be filled before you are discharged.
    [Show full text]
  • Stridor in the Newborn
    Stridor in the Newborn Andrew E. Bluher, MD, David H. Darrow, MD, DDS* KEYWORDS Stridor Newborn Neonate Neonatal Laryngomalacia Larynx Trachea KEY POINTS Stridor originates from laryngeal subsites (supraglottis, glottis, subglottis) or the trachea; a snoring sound originating from the pharynx is more appropriately considered stertor. Stridor is characterized by its volume, pitch, presence on inspiration or expiration, and severity with change in state (awake vs asleep) and position (prone vs supine). Laryngomalacia is the most common cause of neonatal stridor, and most cases can be managed conservatively provided the diagnosis is made with certainty. Premature babies, especially those with a history of intubation, are at risk for subglottic pathologic condition, Changes in voice associated with stridor suggest glottic pathologic condition and a need for otolaryngology referral. INTRODUCTION Families and practitioners alike may understandably be alarmed by stridor occurring in a newborn. An understanding of the presentation and differential diagnosis of neonatal stridor is vital in determining whether to manage the child with further observation in the primary care setting, specialist referral, or urgent inpatient care. In most cases, the management of neonatal stridor is outside the purview of the pediatric primary care provider. The goal of this review is not, therefore, to present an exhaustive review of causes of neonatal stridor, but rather to provide an approach to the stridulous newborn that can be used effectively in the assessment and triage of such patients. Definitions The neonatal period is defined by the World Health Organization as the first 28 days of age. For the purposes of this discussion, the newborn period includes the first 3 months of age.
    [Show full text]