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Med J Bakirkoy. 2006; 2(3): 104-105


Cause of severe respiratory distress in a newborn: a case of laryngo-tracheomalacia

Serdar Cömert, Ayça Vitrinel, N Ayça Gül, Feza Aksoy, Yasemin Akın, Turgut Ağzıkuru, Gülay Çiler Erdağ.

Abstract
Upper airway obstruction in neonatal period is rare. The obstructive airway anomalies that may cause respiratory distress in newborns
are nasal-nasopharyngeal, oral-oropharyngeal, laryngeal and tracheal lesions. The most common symptom is stridor. Apnea, cyanosis,
dyspnea, retractions, hypercapnia, feeding intolerance, abnormal cry and cough may be seen. The most common cause of stridor in
neonatal period is laryngomalacia. Tracheomalacia is the most frequent type of tracheal airway anomaly. Though in mild cases treatment
is conservative, severe cases may require surgery and tracheotomy.
A child born 3500 g. with spontaneous vaginal delivery, resuscitated in the delivery room with positive pressure ventilation was admitted
to the Neonatology Unit with findings of hypotonia, cyanosis and inspiratory stridor. The child developed severe respiratory distress and
due to worsening of blood gases she was intubated and ventilated with mechanical ventilation. Since severe laryngomalacia and
tracheomalacia were observed during bronchoscopy, the child was operated to perform tracheostomy. With this case report we tried to
emphasize that although laryngomalacia frequently observed during neonatal period usually disappears with conservative treatment,
severe forms of the disease may cause severe respiratory distress in newborns and surgical treatment may also be needed in coexistance
with tracheomalacia.

Key words: Neonate, respiratory distress, laryngomalacia, tracheomalacia



Yenidoğanda Ciddi Solunum Sıkıntısı

Özet
Yenidoğanda üst solunum yolu tıkanıklığı nadirdir. Yenidoğanda solunum sıkıntısı yaratabilecek hava yolu tıkanıklıkları nazalnazofarengeal,
oro-orofarengeal, larengeal ve trakeal lezyonlardır. En sık semptom stridor iken siyanoz, apne, dispne, retraksiyonlar,
hiperkapni, beslenme güçlüğü, anormal ağlama, öksürük görülebilir. Laringomalasi yenidoğanda stridorun en sık nedenidir. Trakeal hava
yolu anomalilerinden en sık görüleni de trakeomalasidir. Tedavi hafif olgularda konservatif iken, ciddi olgularda cerrahi tedavi ve
trakeotomi gerekebilmektedir.
Normal spontan vajinal doğum ile 3500g doğan, doğum odasında resüsite edilerek pozitif basınçlı ventilasyon uygulanan, fizik
muayenesinde hipotonisite, siyanoz ve inspiratuar stridor saptanan bebek Yenidoğan Ünitesine yatırıldı. Solunum sıkıntısı izlemde artan,
kan gazlarında kötüleşme saptanması üzerine entübe edilerek ventilatör desteği verilen olguda yapılan bronkoskopi sonrasında
laringomalasi ve trakeomalasi tespit edildi ve trakeostomi açıldı. Yenidoğan döneminde sık görülen ve çoğu kez konservatif tedavi ile ilerki
aylarda düzelen laringomalasinin, ağır formlarının ileri derecede solunum sıkıntısına neden olabileceği ve trakeomalasi ile birlikteliğinde
cerrahi girişim gerekebileceğini vurgulamak amacıyla bu olguyu sunduk.

Anahtar Kelimeler: Serdar Cömert, Ayça Vitrinel, N Ayça Gül, Feza Aksoy, Yasemin Akın, Turgut Ağzıkuru, Gülay Çiler Erdağ



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