Neonate with Bilateral Vocal Cord Palsy Presenting with Respiratory Distress and Congenital Stridor: A Diagnostic and Therapeutic Challenge

Objective:We recently treated a neonate with biphasic stridor secondary to bilateral vocal cord palsy (BVCP).This experience evoked considerable discussion in our unit; hence, we have outlined our approach to neonatal stridor, the importance of direct visualization using bronchoscopy, and management options in this condition.Case presentation: A full-term male infant presented with biphasic stridor two days after birth.The pre-and peri-natal course was uneventful, but he developed respiratory distress immediately after birth and needed assistive ventilation.There was no remarkable lung disease; the radiographs were reported as normal.We were able to wean him to non-invasive respiratory support within 48 hours, but there was persistent biphasic stridor with increased work of breathing.Extensive evaluation of the airways using flexible and rigid bronchoscopy showed BVCP.There was no change in the vocal cord movement over time, and eventually, on day 38 after birth, we had to perform a tracheostomy.He was successfully discharged home after a few days.So far, after a few months, he continues to tolerate feedings and has shown good growth, but there has been no change in BVCP. Conclusion:Vocal cord palsy should be considered as a possibility in infants who present with stridor and respiratory distress but have a noticeable cry.Transnasal fiberoptic flexible laryngoscopy is an important tool in assessing and monitoring these infants.A comprehensive evaluation should ascertain whether the laryngeal dysfunction is an isolated, primary clinical problem or part of a secondary systemic infectious/syndromic illness.The prognosis will depend on the etiology; isolated vocal cord palsy usually takes months to years to show improvement, so surgical treatment options may have to be explored.In contrast, secondary laryngeal paralysis will need more extensive systemic assessment, monitoring, and prognostication; treatment focused on cure, remission, or rehabilitation might be possible in some infants based on the specific diagnosis.