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Clinical Challenge
November 7, 2019

A Newborn With Stridor and Respiratory Distress

Author Affiliations
  • 1Department of Otolaryngology, University of Rochester, Rochester, New York
JAMA Otolaryngol Head Neck Surg. Published online November 7, 2019. doi:https://doi.org/10.1001/jamaoto.2019.3367

A 0-day-old female neonate exhibited loud stridor and respiratory distress at birth. The pregnancy was uncomplicated, and prenatal ultrasonography results were normal. After spontaneous vaginal delivery at 37 weeks’ gestation, the neonate immediately developed tachypnea, severe retractions, barking cough, hoarse cry, and dusky appearance with oxygen desaturations to 60%, which required continuous positive airway pressure. Despite respiratory support, she was intubated within the first hour of life. The intubating clinician noted a large flesh-colored laryngeal mass and placed a size 3.5 uncuffed endotracheal tube. Ear, nose, and throat evaluation noted that the neonate was intubated and ventilating easily. No craniofacial abnormalities or obvious oral cavity, oropharyngeal, or neck masses were present. Chest radiography was obtained, and results were normal. The patient was subsequently taken to the operating room for direct laryngoscopy and bronchoscopy. Intraoperative evaluation revealed a large submucosal mass involving the left side of the epiglottis, false fold, aryepiglottic fold, and arytenoid that was soft and fluctuant on palpation (Figure 1).

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