Noisy breathing is a common presenting complaint in neonates and is usually benign. Stridor is usually due to congenital anomalies (e.g., webs, cysts, stresia, stenosis, clefts, or hemangiomas) extending anywhere from the nose to the trachea and bronchi. Infants who were intubated in the neonatal period are prone to develop subglottic stenosis. Infection (e.g., croup, epiglottis, and abscess) as a cause of stridor in neonates is rare. Stridor worsening with cry suggests laryngomalacia or subglottic hemangioma; stridor and feeding difficulties suggest vascular ring, laryngeal cleft, or tracheoesophageal fistula; stridor with hoarseness suggests vocal cord paralysis. Laryngomalacia is the most common cause of stridor in the neonate. It is characterized by noisy, crowing inspiratory sounds, which usually improve during the first year of life. When the cause is in doubt, the infant should be admitted for evaluation to determine the cause. 3 37
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