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Published on: August 7, 2017
[Etiologic analysis of severe neonatal upper respiratory tract obstruction]
Li-ping Wang1, Ming Zhang, Wei Li
1Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang 110004, China. wanglp@cmu2h.com
Insights
Congenital diseases cause most severe upper respiratory obstruction in newborns. Prompt diagnosis and treatment of these congenital conditions are crucial for improving outcomes and survival rates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Otolaryngology
Context:
- Severe upper respiratory tract obstruction presents a critical challenge in neonates.
- Accurate diagnosis is essential for effective management and improved patient outcomes.
Purpose:
- This study investigates the primary causes of severe upper respiratory obstruction in neonates.
- The objective is to identify congenital anomalies contributing to neonatal respiratory distress.
Summary:
- A retrospective analysis of 47 neonates with severe dyspnea revealed that congenital diseases accounted for 87.2% of cases.
- Congenital laryngeal stridor and upper respiratory tract cysts were the most frequent diagnoses, with significant rates of misdiagnosis.
- Other causes included laryngotracheobronchitis, respiratory tract stenosis, laryngeal webs, vocal cord paralysis, and genetic syndromes.
Impact:
- Findings underscore the critical role of congenital abnormalities in neonatal respiratory obstruction.
- Highlights the importance of early and accurate diagnosis for timely intervention and better prognosis.
- Emphasizes the need for specialized diagnostic approaches to differentiate various congenital causes and guide treatment strategies.
Objective:
To investigate the causes of severe upper respiratory tract obstruction in neonates.
Methods:
Forty seven cases with severe dyspnea history were reviewed and retrospective analysis performed. Clinical manifestation, direct laryngoscope, CT, X-ray barium meal examination results and the treatment process were recorded.
Results:
Among 47 neonates, 41 cases were congenital diseases, accounting for 87.2% (41/47). In 41 cases, 15 cases were congenital laryngeal stridor, accounting for 31.9%, involving 6 cases accompanied by the gastroesophageal reflux. Fourteen cases were congenital upper respiratory tract cyst (10 cases of lingual root cyst, 3 cases of epiglottis cyst, 1 case of laryngeal cyst), accounting for 29.8%, in which 13 cases were misdiagnosis as congenital laryngeal stridor. Others were 6 cases of acute membrane laryngotracheobronchitis, 3 cases of congenital main respiratory tract stenosis, 2 cases of congenital laryngeal webs, 2 cases of vocal cord paralysis, 3 cases of Pierre Robin syndrome, 2 cases of Cri-du-chat syndrome. Except for 3 in 47 cases whose parents refused treatment, dyspnea in other 44 cases were relieved with inhaling oxygen and drug treatment, 37 case received tracheal intubation and sputum suction, 19 cases received direct laryngoscope or self-retaining laryngoscope operation.
Conclusions:
Congenital disease is the main cause of severe upper respiratory tract obstruction. For the neonates suffering from severe upper respiratory obstruction, finding out the cause and prompt treatment are essential for prognosis and reducing mortality.
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