Posod Anna, Griesmaier Elke, Brunner Andrea, Pototschnig Claus, Trawöger Rudolf, Kiechl-Kohlendorfer Ursula
Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria.
BMC Pediatr. 2016 Jan 5;16:1. doi: 10.1186/s12887-015-0539-9.
Neonatal inspiratory stridor is an important examination finding that requires immediate and adequate evaluation of the underlying etiology. Depending on the severity of the airway obstruction and the presence or absence of associated symptoms such as respiratory distress and feeding problems, early initiation of a complete diagnostic workup can be crucial. The most common cause of neonatal inspiratory stridor is laryngomalacia, however, several differential diagnoses need to be investigated. More rare causes include oral or laryngeal masses. Teratomas of the head and neck region are one of the most unusual causes of respiratory distress during the neonatal period. We present a case of a mature teratoma in the oropharynx presenting with airway obstruction in a newborn infant.
A four-day-old female Caucasian infant was admitted to the neonatal intensive care unit of our hospital because of inspiratory stridor and profound desaturations while feeding. Diagnostic workup by ultrasound, magnetic resonance imaging and flexible endoscopy revealed a pediculated lesion in the pharyngeal region causing intermittent complete airway obstruction. The mass was surgically removed by transoral laser resection on the seventh day of life. Histological evaluation was consistent with a mature teratoma without any signs of malignancy. The further hospital course was uneventful, routine follow-up examinations at 3, 6 and 9 months of age showed no evidence of tumor recurrence.
Neonatal stridor is a frequent symptom in the neonatal period and is mostly caused by non-life-threatening pathologies. On rare occasions, however, the underlying conditions are more critical. A careful stepwise diagnostic investigation to rule out these conditions, to identify rare causes and to initiate early treatment is therefore warranted.
新生儿吸气性喘鸣是一项重要的检查发现，需要对潜在病因进行及时且充分的评估。根据气道阻塞的严重程度以及是否存在呼吸窘迫和喂养问题等相关症状，尽早开始全面的诊断性检查至关重要。新生儿吸气性喘鸣最常见的原因是喉软化症，然而，需要对几种鉴别诊断进行调查。更罕见的原因包括口腔或喉部肿物。头颈部畸胎瘤是新生儿期呼吸窘迫最不常见的原因之一。我们报告一例口咽成熟畸胎瘤导致新生儿气道阻塞的病例。
一名4日龄白种女性婴儿因吸气性喘鸣和喂养时严重低氧血症入住我院新生儿重症监护病房。通过超声、磁共振成像和软性内镜进行的诊断性检查发现咽部有一个带蒂病变，导致间歇性完全气道阻塞。在出生后第7天通过经口激光切除术将肿物手术切除。组织学评估结果与成熟畸胎瘤一致，无任何恶性迹象。后续住院过程顺利，3个月、6个月和9个月龄时的常规随访检查未发现肿瘤复发迹象。
新生儿喘鸣是新生儿期常见症状，大多由非危及生命性病变引起。然而，在极少数情况下，潜在病情更为严重。因此，有必要进行仔细的逐步诊断性调查，以排除这些情况、识别罕见病因并尽早开始治疗。
