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Neonatal stridor

Clinical Discipline(s)/Organ System(s)
Otorhinolaryngology, Paediatrics, Respiratory System, General Practice
Progress Test Topic(s)
Child health
Description
A 3 week old Cook Island Māori infant is seen by her GP. The Plunket nurse is concerned about stridor, which has been present almost all the time since birth.
Applied Science for Medicine 
   - Anatomy and physiology of the upper respiratory tract
   - Pathophysiology of stridor and wheeze
   - Microbiology of upper respiratory illness including croup, epiglottitis/supraglottitis and tracheitis
Clinical and Communication Skills 
   - Describe common causes of coughing, wheezing and stridor in neonates and infants
   - Recognition of stridor as medical emergency
   - Obtain adequate history regarding duration and severity of airway symptoms (including effect on feeding, exacerbating factors, apnoeas, cyanotic episodes, reflux/vomiting, voice quality, vaccination status)
   - Plot weight from birth on growth chart
   - Be able to distinguish between: stertor, stridor and wheeze
   - Clinically assess: nasal patency, oral cavity, neck
   - Perform a respiratory examination in a child (including assessing work of breathing (check oxygen saturations, examine for use of accessory muscles, tracheal tug, subcostal recession, pectus excavatum, cutaneous haemangiomas - head, neck and chest must be fully exposed)
   - Consider what investigations or referrals would be appropriate
   - Knowledge of treatment options for causes of stridor
Hauora Māori 
   - Appropriate engagement and consultation with whānau
   - Acknowledgement of the disproportionate impact of illness on whānau employment/income, and therefore availability and models of caregiving
Population Health 
   - Immunisation schedule in New Zealand
   - Access to specialist paediatric surgery services and emergency airway support in New Zealand
Conditions to be considered relating to this scenario
Common
laryngomalacia, croup
Less common but 'important not to miss'
congenital laryngeal abnormalities (e.g. vocal cord palsy), laryngeal web, subglottic stenosis, epiglottitis/supraglottitis, deep neck space infection, inhaled foreign body, tracheomalacia, tracheo-oesophageal fistula, anaphylaxis
Uncommon
external tracheal compression (e.g. vascular ring), vocal fold cyst, vocal fold nodule, vocal fold papilloma