Technologic advancements and improvements in supportive care have resulted in increased survival of very low birth weight and premature infants. With salvage of these high risk newborns, many difficult management problems arise. Respiratory distress of the newborn is the most common airway problem that affects these patients and subglottic edema or stenosis may frequently complicate management of the airway. Decision-making in airway maintenance and respiratory care can be problematic due to multiple factors that must be considered. The otolaryngologist is often consulted when upper airway obstruction is suspected. Relevant respiratory physiology is reviewed in order to help direct therapeutic decision-making. Parameters of assessment are enumerated and methods for choosing among therapeutic alternatives are presented. A paradigm to aid in differential diagnosis is described.
StahlmanMT. Acute respiratory disorders in the newborn. In: AveryGB, ed. Neonatology: Pathophysiology and management of the newborn. 2nd ed.Philadelphia: JB Lippincott, 1981.
8.
JonesRBodnarARoanYJohnsonD. Subglottic stenosis in newborn intensive care unit graduates. Am J Dis Child1981; 135: 367–8.
WungJTKoonsAHDriscollJMJamesLS. Changing incidence of bronchopulmonary dysplasia. J Pediatr1979; 95: 845–7.
11.
HodsonWATruogWEMayockDELyreneRWoodrumDE. Bronchopulmonary dysplasia: The need for epidemiologic studies. J Pediatr1979; 95: 848–51.
12.
EhrenkranzRAWarshawJB. Chronic lung disease in the newborn. In: SternL, ed. Diagnosis and management of respiratory disorders in the newborn. Menlo Park, Calif: Addison-Weslep, 1983.
13.
NorthwayWH. Observations on bronchopulmonary dysplasia. J Pediatr1979; 95: 815–8.
14.
WongYCGeardsmoreCSSilvermanM. Pulmonary sequelae of neonatal respiratory distress in very low birthweight infants: A clinical and physiological study. Arch Dis Child1982; 57: 418–24.
15.
GerhardtTBancalariE. Apnea of prematurity: 1. Lung function and regulation of breathing. Pediatrics1984; 74: 58–62.
16.
Henderson-SmartDJPettigrewAGCampbellDJ. Clinical apnea and brainstem neural function in preterm infants. N Engl J Med1983; 308: 353–7.
17.
ThachBTStarkAR. Spontaneous neck flexion and airway obstruction during apneic spells in preterm infants. J Pediatr1979; 94: 275–81.
18.
MathewOPRobertsJLThachBT. Pharyngeal airway-obstruction in preterm infants during mixed and obstructive apnea. J Pediatr1982; 100: 964–8.
19.
DransfieldDASpitzerARFoxWW. Episodic airway obstruction in premature infants. Am J Dis Child1983; 137: 441–3.
20.
VolpeJJ. Neonatal intraventricular hemorrhage. N Engl J Med1981; 304: 886–91.
21.
Garcia-PratsJAProcianoyRSAdamsJMRudolphAJ. The hyaline membrane disease-intraventricular hemorrhage relationship in the very low birth weight infant: Perinatal aspects. Acta Paediatr Scand1982; 71: 79–84.
22.
SzymonowiczWYuVWilsonFE. Antecedents of periventricular hemorrhage in infants weighing 1250 g or less at birth. Arch Dis Child1984; 59: 13–7.
23.
McDonaldMMKoopsBLJohnsonML. Timing and antecedents of intracranial hemorrhage in the newborn. Pediatrics1984; 74: 32–6.
24.
JacobJGluckLDiSessaT. The contribution of PDA in the neonate with severe RDS. J Pediatr1980; 96: 79–87.
25.
ClymanR. The role of the patent ductus arteriosus in respiratory distress syndrome. Semin Perinatol1984; 8: 293–9.
26.
AveryGBFletcherABKaplanMBrudnoDS. Controlled trial of dexamethasone in respirator-dependent infants with bronchopulmonary dysplasia. Pediatrics1985; 75: 106–11.
27.
HawkinsDBCrockettDMShumTK. Corticosteroids in airway management. Otolaryngol Head Neck Surg1983; 91: 593–6.
28.
FishmanRAPashleyNRT. A study of the premature neonatal airway. Otolaryngol Head Neck Surg1981; 89: 604–7.
29.
SchildJA. Relationship of laryngeal dimensions to body-size and gestational age in premature neonates and small infants. Laryngoscope1984; 94: 1284–92.
