Optimal Management of a 2-Hour-Old Newborn With Severe Congenital Subglottic Stenosis and Multiple Congenital Heart Diseases

Abstract

Introduction:

Congenital subglottic stenosis (C-SGS) is the third most common congenital anomaly of the larynx. It necessitates tracheotomy in newborns if it causes severe airway obstruction. When the negative impact of tracheostomy cannot be tolerated, as in presence of congenital heart disease requiring further surgical intervention, other alternative procedures are required. This case report is the first of its kind reporting airway expansion in a neonate in the first few hours after birth.

Case Report:

A 38-week-fetus male was born with multiple congenital heart anomalies and C-SGS of grade III. Single-stage laryngotracheoplasty (SS-LTP) with anterior thyroid alar cartilage (TAC) grafting was performed. Our team was fully aware of all potential risks during SS-LTP procedure in such debilitated patient.

Discussion:

Treatment of C-SGS in premature neonates is tracheostomy to avoid prolonged intubation. In some cases, tracheostomy is not a good option as in presence of congenital heart disease necessitating urgent further surgical interventions. Among all surgical procedures to augment the airway without tracheostomy, SS-LTP with placement of anterior TAC graft was our choice.

Conclusion:

This case report demonstrated that SS-LTP with anterior TAC graft can be performed in a newborn with severe C-SGS and congenital heart disease. It can alleviate the need for tracheostomy and avoid unnecessary delay for subsequent cardiac interventions. However, further study is likely needed to make a definitive statement of its safety and efficacy.