Neonatal – NICU

Subglottic Stenosis in Neonates, Infants, Children

Subglottic stenosis refers to a narrowing of the airway in an infant just below the vocal cords, which is called the subglottis.  There are two causes of subglottic stenosis, the first being congenital, meaning the defect happened in utero, or while the infant was still developing inside the mother.  This is called congenital subglottic stenosis.  Congenital subglottic stenosis happens when the airway cartilege develops abnormally before birth.

The second cause can be related to scarring from intubation.

Signs of Subglottic Stenosis

• Loud breathing, also known as strider, which is breathing accompanied by a high pitch sound.
• Unable to breathe without a tracheostomy tube.
• Recurring croup, which is when an infant or child has difficulty breathing and is accompanied by a rough, “barking” cough.

Treatment

Treatment for subglottic stenosis depends on the severity of the narrowing and the amount of scarring, in addition to how difficult breathing is for the neonate or infant.

For mild cases, regular observation and medication may be prescribed.  If further treatment is necessary, the doctor may perform an endoscopy, where a small, thin tube with a light and camera will be navigated down the infant’s airway to view the blockage.  At this point, the doctor can then inflate the airway with a balloon, causing it to stretch, or can remove the excess scarring with a laser.

For more severe, critical cases, a tracheotomy tube will often need to be used to allow the infant or child to breathe.

See Also:

• The Children’s Hospital of Philadelphia – Subglottic Stenosis
• Children’s Ear, Nose, and Throat of Houston – Subglottic Stenosis
• emedicine Pediatrics: Subglottic Stenosis