neonatal laryngeal stridor
Introduction
Introduction The newborn's laryngeal stridor of newborn indicates that the throat wheezing sound that occurs during birth or within a few weeks after birth is caused by airflow through the narrow airway segment during breathing, which can be caused by multiple causes. Severe stenosis can cause dyspnea or even respiratory failure. Whether there is a birth injury through medical history, whether there is any improper operation, damage to the recurrent laryngeal nerve, whether there is a history of mechanical ventilation of tracheal intubation, and whether the mother's nutritional status during pregnancy has hypocalcemia, etc., combined with direct laryngoscopy and imaging examination, can We identified congenital or acquired laryngeal and identified various etiological diagnoses.
Cause
Cause
Common causes of laryngeal wheezing caused by diseases in the throat or near the throat are as follows:
1. Congenital:
Congenital simple laryngeal wheezing (laryngeal tracheal cartilage softening) congenital laryngotracheal dysplasia (throat double dissection of the throat, epiglottis over the subglottic stenosis, tracheal stenosis, etc.), congenital macrovascular abnormalities (double aortic arch), congenital Throat cyst or tumor (throat cyst, laryngeal hemangioma, thyroid gland in laryngeal papilloma, etc.).
2. Acquired:
Traumatic laryngeal wheezing (production injury, laryngeal edema, acquired subglottic stenosis), neurological laryngeal wheezing (vocal cord paralysis, throat and neuromuscular incoordination).
Pathogenesis:
The throat is caused by turbulence of the airflow through the narrow section of the airway during inhalation or exhalation.
1. Physiological and anatomical features:
Neonates are prone to stenosis due to small airway diameters, and cartilage that supports airways is poorly developed, making them prone to distortion and collapse. Therefore, neonatal airways are more susceptible to physiological stenosis than children of other age groups.
Anatomically, the airway can be divided into three parts: 1 upper part of the glottis: including the nasopharyngeal cavity, the oropharynx cavity and the hypopharynx. 2 throat segment (soundslide segment): including vocal cord, subglottic region, neck tracheal segment 3 intrathoracic segment: including the trachea and bronchi in the thoracic cavity.
2. Inspiratory throat:
The upper part of the glottis is the weakest part of the newborn. Obstructive diseases in this area can often cause inspiratory throat, such as small jaw or giant tongue deformity, which can block the airway because the tongue is backwards.
3. Biphasic throat:
The larynx is the most anatomically narrow part of the airway of the newborn. Diseases such as congenital laryngeal softening vaginal discharge, subglottic stenosis, subglottic hemangioma and laryngeal cyst can cause laryngeal obstruction. Both gas and exhalation are equally affected, and therefore manifest as a typical biphasic throat.
4. Exhaled throat:
Congenital anomalies of the trachea and bronchus in the lumen are relatively rare, such as tracheal softening of the tracheal stenosis, congenital macrovascular abnormal compression of the airway, or recurrent airway esophageal reflux caused by airway inflammation can cause airway obstruction in this segment And the expression is exhaled throat.
Examine
an examination
Related inspection
Obstetric B-ultrasound angiography amniotic fluid bilirubin Toxoplasma antibody maximum expiratory flow-volume curve (MEFV)
According to the history and symptoms, it is not difficult to make a diagnosis of neonatal laryngeal wheezing. In addition to the history and clinical features, direct laryngoscopy or fiberoptic laryngoscopy should be used to determine the nature of laryngeal malformation. Direct laryngoscopy often confirms the diagnosis of congenital simple laryngeal throat laryngeal cysts, laryngeal epiglottis, and vocal cord paralysis. However, subglottic and tracheal lesions must be diagnosed by bronchoscopy. X-ray film and esophageal swallowing examination, etc., to determine the cause of neonatal laryngeal diagnosis as soon as possible.
Laboratory inspection:
The throat caused by infantile hand, foot and ankle can have low blood calcium. And there is an increase in peripheral blood leukocytes and neutrophils in the infection.
Other auxiliary inspections:
1. Direct laryngoscopy: the most important diagnostic method. Congenital simple laryngeal wheezing direct laryngoscopy shows that the laryngeal tissue is soft and slack when inhaled, and the laryngeal tissue curls into the larynx. When exhaling, if the direct laryngoscope is used, it will be irritated or stretched into the vestibule of the larynx. Disappearance can be determined to diagnose the laryngeal cyst tumor epiglottis and vocal cord paralysis can only be confirmed by laryngoscopy.
2. Bronchoscopy: bronchoscopy should be performed under the glottic and tracheal lesions to confirm the diagnosis with bronchoscopy.
3. X-ray examination: X-ray film and esophageal swallowing examination of the neck and chest are helpful for diagnosing the cause of neonatal throat
4. Ultrasound examination: If necessary, cardiac ultrasound examination can help diagnose the cause of neonatal throat.
Diagnosis
Differential diagnosis
In order to rule out the throat seen in infantile hand, foot and ankle, it is sometimes necessary to measure serum calcium. In addition, it should be differentiated from the following diseases:
1. Other diseases of the throat: congenital laryngeal cysts can occur in the upper glottic area or near the epiglottis. In the neonatal period, it shows laryngeal wheezing and inspiratory dyspnea. When lying on the side or head tilting, the symptoms may vary to different degrees. The relief is generally silent, and a direct laryngoscopy or fiberoptic laryngoscopy can confirm the diagnosis and should be removed as soon as possible.
2. Tracheal abnormalities: congenital tracheal fistula, tracheal stenosis, etc. can cause wheezing. The tracheal cartilage ring is weak, the deformed island shape is residual or absent, and the horseshoe-shaped tracheal ring is flattened, which can make the tracheal wall weakly resist the pressure outside the tracheal cavity, or because the membrane part of the tracheal wall is close to the anterior wall of the trachea, so that the trachea will be aversion Laryngeal wheezing can occur.
In addition, secondary to the long-term compression of the trachea or bronchus may cause laryngeal or dyspnea, such as lymph nodes and thymus hypertrophy of the neck tumor can compress the trachea and bronchus leading to secondary softening and cause throat and breathing difficulties Chest X-ray, tracheal lipiodol angiography, fiberoptic bronchoscopy, chest spiral CT and other examinations can help diagnose.
3. Small jaw: It is characterized by small jaw, short or thick tongue, inhalation with snoring, and obvious inspiratory difficulty. When inhaling, the patient's lower jaw is closed to the posterior mouth, and the root of the tongue is falling backward. The soft palate is lifted up, causing the nasopharyngeal cavity to be blocked, causing severe breathing difficulties. The scabbard is most obvious, so the clinical concealed funnel chest is sometimes mistaken. Let the child take the side or prone position, and lift the lower jaw by hand to relieve difficulty. Sick children often cannot breastfeed due to difficulty in breathing, resulting in malnutrition and respiratory infections. Usually only the child is placed in the lateral position, sometimes the lower jaw is lifted with a simple jaw bracket, and a silicone tube can be placed along the corner to improve ventilation.
