Abstract
Increasingly complex patients treated in neonatal intensive care units create a unique set of challenges in managing the neonate’s airway including both anatomical and physiological considerations that differentiate them from the general pediatric or adult populations. Potential airway emergencies can be classified into profiles such as the unanticipated emergency in the non-intubated patient, the unanticipated emergency in the intubated patient, and patients with tracheostomy. Furthermore, neonatal airways can be classified by severity in being considered either difficult or critical. These neonatal specific clinical challenges have recently substantiated the need for a distinct neonatal airway algorithm.
A neonatal airway emergency can be effectively managed by a strategy for anticipation, identification, preparation, mobilization, and execution. This strategy is strengthened by regular education of the team and frequent simulation of airway emergencies. Following a predetermined pathway for activating an airway emergency alert and having all necessary equipment readily available are essential components of a well-defined strategy. Finally, quality improvement projects can maximize efficacy by focusing on improving the airway emergency response and perioperative communications as well as initiating a neonatal specific airway safety rounds with a multidisciplinary team.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Altman KW, Wetmore RF, Marsh RR. Congenital airway abnormalities in patients requiring hospitalization. Arch Otolaryngol Head Neck Surg. 1999;125(5):525–8. PubMed PMID: 10326809.
Arensman R. Surgical intervention for respiratory distress and airway management. In: Goldsmith J, Karotkin E, editors. Assisted ventilation of the neonate. 5th ed. Philadelphia: Elsevier Saunders; 2011.
Bergeson PS, Shaw JC. Are infants really obligatory nasal breathers? Clin Pediatr (Phila). 2001;40(10):567–9. PubMed PMID: 11681824.
Bull P. Evaluation of the pediatric airway by rigid endoscopy. In: Mayer C, Cotton R, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 1996.
Carrelton S, Brown C. Bag mask ventilation. In: Walls R, Murphy M, editors. Manual of emergency airway management. Philadelphia: Lippincott Williams & Wilkins; 2012.
Cotton R, Prescott CA. Congenital anomalies of the larynx. In: Cotton R, Mayer C. ed. Philadelphia: Lippincott Williams & Wilkins; 1996.
Desai B, Beattie L, Ryan MF, Falgiani M. Visual diagnosis: pediatric airway emergency. Case Rep Emerg Med. 2012;2012:495363. PubMed PMID: 23326717. Pubmed Central PMCID: 3542885.
Dickison AE. The normal and abnormal pediatric upper airway. Recognition and management of obstruction. Clin Chest Med. 1987;8(4):583–96. PubMed PMID: 3322644.
Dieckmann R. Pediatric assessment. In: Gausche-Hill M, Fuchs S, Yamamoto L, editors. APLS: the pediatric emergency medicine. 4th ed. Sudbury: Jones and Bartlett; 2004.
Drummond GB. Keep a clear airway. Br J Anaesth. 1991;66(2):153–6. PubMed PMID: 1817613.
Fearon B, Whalen JS. Tracheal dimensions in the living infant (preliminary report). Ann Otol Rhinol Laryngol. 1967;76(5):965–74. PubMed PMID: 6074243.
Fiascone J, Vreel P. Neonatal lung disease and respiratory care. In: Burton G, Hodgkin JE, Ward J, editors. Respiratory care: a guide to clinical practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 1997.
Finer NN, Rich W, Wang C, Leone T. Airway obstruction during mask ventilation of very low birth weight infants during neonatal resuscitation. Pediatrics. 2009;123(3):865–9. PubMed PMID: 19255015.
Gerber M, Dunham ME, Holinger LD. Stridor, aspiration and cough. In: Byron J, editor. Bailey’s head & neck surgery—otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 2001.
Gibson S. Aerodigestive tract foreign bodies. In: Cotton R, Mayer C, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 1996.
Hess D, Susan P. Neonatal lung disease and respiratory care. In: Burton J, Hodgkin M, Ward J. (eds.) 4th ed. Lippincott Williams & Wilkins; 1997.
Hobolth N, Buchmann G, Sandberg LE. Congenital choanal atresia. Acta Paediatr Scand. 1967;56(3):286–94. PubMed PMID: 5340416.
Hudgel DW, Hendricks C. Palate and hypopharynx–sites of inspiratory narrowing of the upper airway during sleep. Am Rev Respir Dis. 1988;138(6):1542–7. PubMed PMID: 3202504.
Jacobs I. Bronchoscopy. In: Mattei P, editor. Fundamentals of pediatric surgery. New York: Springer; 2011.
John S, Swischuk LE. Airway imaging in children. In: Johnson J, Newlands S, Bailey BJ, editors. Bailey’s head & neck surgery—otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 2001.
Karlovich G, Goldsmith J, Karotkin E. Resusication. In: Goldsmith J, Karotkin K, editors. Assisted ventilation of the neonate. 5th ed. New York: Elsevier Saunders; 2011.
Keller JL, Kacker A. Choanal atresia, CHARGE association, and congenital nasal stenosis. Otolaryngol Clin North Am. 2000;33(6):1343–51. viii. PubMed PMID: 11449791.
Keller R, Farmer D. Surgical disorders of chest and airways. In: Tauesch E, Gleason M, Devaskar S, editors. Avery’s diseases of the newborn. New York: Elsevier Saunders; 2010.
Kurth CD, LeBard SE. Association of postoperative apnea, airway obstruction, and hypoxemia in former premature infants. Anesthesiology. 1991;75(1):22–6. PubMed PMID: 2064055.
Litman RS, Weissend EE, Shibata D, Westesson PL. Developmental changes of laryngeal dimensions in unparalyzed, sedated children. Anesthesiology. 2003;98(1):41–5. PubMed PMID: 12502977.
Lowinger D, Ohlms L. Otolaryngology: head and neck surgery. In: Hansen A, Pudler M, editors. Manual of neonatal surgical intensive care. 2nd ed. Shelton: People’s Medical Publishing House; 2009. p. 70–118.
Luten R, Kissoon N. Approach to the pediatric airway. In: Walls R, Murphy MF, Luten RC, editors. Manual of emergency airway management. Philadelphia: Lippincott, Williams & Wilkins; 2004. p. 263–81.
Luten R, Mick N. Differentiating aspects of pediatric airway. In: Walls R, Murphy M, editors. Manual of emergency airway management. 4th ed. Philadelphia: Lippincott, Williams & Wilkins; 2012.
Mace SE, Khan N. Needle cricothyrotomy. Emerg Med Clin North Am. 2008;26(4):1085–101. xi. PubMed PMID: 19059102.
Maniglia AJ, Goodwin Jr WJ. Congenital choanal atresia. Otolaryngol Clin North Am. 1981;14(1):167–73. PubMed PMID: 7254838.
Mehta R, Hariprakash S, Cox P, Wheeler D. Diseases of upper respiratory tract. In: Wheeler D, Wong H, Shanley T, editors. The respiratory tract in pediatric critical illness and injury. New York: Springer; 2009.
Miller MJ, Carlo WA, Strohl KP, Fanaroff AA, Martin RJ. Effect of maturation on oral breathing in sleeping premature infants. J Pediatr. 1986;109(3):515–9. PubMed PMID: 3746545.
Morley C. Continuous distending pressure. Arch Dis Child Fetal Neonatal Ed. 1999;81(2):F152–6. PubMed PMID: 10448188. Pubmed Central PMCID: 1720991.
Moss I. Physiologic considerations. In: McMillian J, Feigin RD, DeAngelis CD, editors. Oski’s pediatrics. Philadelphia: Lippencott Williams & Wilkins; 2006. p. 300–5.
Myer 3rd CM, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994;103(4 Pt 1):319–23. PubMed PMID: 8154776.
Myers C. Inflammatory diseases of the pediatric airway. In: Cotton R, Mayer C, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 1996.
Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Dore CJ. Effect of general anaesthesia on the pharynx. Br J Anaesth. 1991;66(2):157–62. PubMed PMID: 1817614.
Othetrsen H, Andre H. Choanal atresia, intraoral obstructions, laryngeal obstructions, laryngomalacia, webs, atresia, laryngoceles, lymphangiomas and hemangiomas papilloma. Ashcraft and holder: pediatric surgery. New York: W.B. Saunders; 1993.
Paterson SJ, Byrne PJ, Molesky MG, Seal RF, Finucane BT. Neonatal resuscitation using the laryngeal mask airway. Anesthesiology. 1994;80(6):1248–53; discussion 27A. PubMed PMID: 8010471.
Polgar G. Airway resistance in the newborn infant. Preliminary communication. J Pediatr. 1961;59:915–21. PubMed PMID: 14487521.
Polgar G, Kong GP. The nasal resistance of newborn infants. J Pediatr. 1965;67(4):557–67. PubMed PMID: 5833190.
Pudler M. Cleft Lip/Palate and Robin Sequence. In: Hansen A, Pudler M, editors. Otolaryngology: head and neck surgery. 2nd ed. Shelton: People’s Medical Publishing House; 2009.
Rennie J. Neonatal resuscitation. In: Donn S, Sinha S, editors. Manual of neonatal respiratory care. New York: Springer; 2012.
Rutter M. Congenital airway and respiratory tract anomalies. In: Wheeler D, Wong H, Shanley T, editors. The respiratory tract in pediatric critical illness and injury. New York: Springer; 2009. p. 163–93.
Santillanes G, Gausche-Hill M. Pediatric airway management. Emerg Med Clin North Am. 2008;26(4):961–75. ix. PubMed PMID: 19059095.
Sarnaik A, Heidemann SM. Respiratory pathophysiology and regulation. In: Kleigman R, Rehrman RE, Jenson HB, editors. Nelson’s textbook of pediatrics. 18th ed. Philadelphia: Saunders; 2007.
Scanlon C, Spearman C, Sheldon R. Neonatal and pediatric respiratory care. In: Kacmarek R, Stoller J, Heuer A, editors. Egan’s fundamentals of respiratory care. 10th ed. New York: Springer; 1995.
Schaffer T, Wolfson M. Upper airway: structure, function and development. In: Abman S, Polin R, Fox W, editors. Fetal and neonatal physiology. 4th ed. Philadelphia: Elsevier Saunders; 2011.
Schmolzer GM, Dawson JA, Kamlin CO, O’Donnell CP, Morley CJ, Davis PG. Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room. Arch Dis Child Fetal Neonatal Ed. 2011;96(4):F254–7. PubMed PMID: 21081593.
Stern Y, Cotton RT. Evaluation of the noisy infant. In: Cotton R, Charles M, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 2001.
Vauthy P. Evaluation of the pediatric airway by flexible endoscopy. In: Cotton R, Mayer C, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott, Williams & Wilkins; 1999.
Walner D, Cotton RT. Acquired anomalies of the larynx and trachea. In: Cotton R, Mayer C, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott Williams & Wilkins; 1996.
Wetmore R. Management of acute airway obstruction. In: Wetmore R, Muntz HR, McGill TJ, editors. Pediatric otolaryngology: principles and practice pathways. New York: Thieme; 2000.
Wetmore R. Tracheotomy. In: Wetmore R, Muntz HR, McGill TJ, editors. Pediatric otolaryngology. Philadelphia: Springer; 2003.
Wetmore RF, Marsh RR, Thompson ME, Tom LW. Pediatric tracheostomy: a changing procedure? Ann Otol Rhinol Laryngol. 1999;108(7 Pt 1):695–9. PubMed PMID: 10435931.
Wheeler D, Spaeth J, Mehta R, Hariprakash S, Cox P. Assesment and management of pediatric airway. In: Wheeler D, Wong H, Shanley T. (eds.) New York: Springer; 2009.
Whitaker K. Assessment of the neonatal and pediatric patients. In: Whitaker K, editor. Comprehensive perinatal & pediatric respiratory care. 3rd ed. New York: Delmar; 2001.
Wilson TG. Stridor in infancy. J Laryngol Otol. 1952;66(9):437–51. PubMed PMID: 12990908.
Wiseman K, Donn S. Laryngoscopy and endotracheal intubation. In: Donn S, Sinha S, editors. Manual of neonatal respiratory care. 3rd ed. New York: Springer; 2012.
Wittenborg MH, Gyepes MT, Crocker D. Tracheal dynamics in infants with respiratory distress, stridor, and collapsing trachea. Radiology. 1967;88(4):653–62. PubMed PMID: 6020927.
Wood R. Bronchoscopy in pediatric intensive care unit. In: Wheeler D, Wong H, Shanley T, editors. The respiratory tract in pediatric critical illness and injury. New York: Springer; 2009.
Wycoff M, McGowan J, Coby C, Fairchild K, Henry L, Steven R. Textbook of neonatal resuscitation. In: McGowan J, ed. 6th ed. Elkgrove: American Academy of Pediatrics and American Heart Association; 2012.
Zur K. The critical airway. In: Mattei P, editor. Fundamentals of pediatric surgery. New York: Springer; 2011.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Lioy, J., Deshmuhk, H., Paliga, J.T. (2015). Challenges of the Neonatal Airway. In: Lioy, J., Sobol, S. (eds) Disorders of the Neonatal Airway. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1610-8_15
Download citation
DOI: https://doi.org/10.1007/978-1-4939-1610-8_15
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-1609-2
Online ISBN: 978-1-4939-1610-8
eBook Packages: MedicineMedicine (R0)