This 2-week-old female infant with stridor since birth was born full-term and weighed 2.9 kg. The prenatal course and the delivery were uncomplicated. The placenta and the amniotic fluid were normal. The Apgar scores were 8 and 9 at one and five minutes, respectively.
Slight suprasternal retractions accompanied each inspiratory stridor. The stridor became worse during vigorous crying or after each feeding, but there was no swallowing difficulty, milk regurgitation, or choking. Nor was there cyanosis, hoarseness, murmur, or wheezing. The peripheral pulses were intact.
Chest roentgenograms, electrocardiograms, and results of the initial blood gas tests were normal. Direct laryngoscopy revealed neither intraluminal lesions nor vocal cord paralysis.
Excessive upper airway secretions led to severe respiratory distress and marked respiratory acidosis, which necessitated emergency tracheostomy to facilitate repeated suctioning of the airway. The infant was comfortable with the tracheostomy tube but developed inspiratory difficulty whenever the cannula was removed.