Neonatal Airway Anomalies: A 12-year Experience of a Multidisciplinary Team at a Tertiary Care Center

Importance Neonatal airway disorders frequently pose a serious risk to life and create difficult diagnostic and therapeutic concerns, contributing to significant neonatal mortality and morbidity. Objectives To describe the clinical profile, management, and outcomes of neonatal airway anomalies and to determine the predictors of mortality in neonates with airway anomalies. Materials and Methods We conducted a medical record-based retrospective observational study at a tertiary care outborn neonatal unit in India, which included neonates diagnosed with airway anomalies as per the International Classification of Diseases (ICD) code, admitted from October 2013 to March 2023. Our outcome was to describe the clinical profile, management, and outcomes and to determine the predictors of mortality in neonates with airway anomalies. Results Among the 307 neonates studied, 56% were males, and the median age at admission was 6 days. The most frequent indication for direct laryngoscopy (DLS) and fiber-optic bronchoscopy was stridor with retractions. Laryngomalacia (81%) and sub-glottis stenosis (8%) were most common among the upper and lower airway anomaly findings, respectively. Among our dataset, 287 (93%) were discharged and 20 (7%) succumbed. The need for resuscitation and the presence of other systemic anomalies were independently associated with mortality. Conclusions and Relevance Laryngomalacia accounted for the majority of cases. However, morbidity and mortality were high in those with synchronous-airway anomalies and when associated with other systemic anomalies. The presence of stridor and retractions mandated the airway evaluation procedures, which were safe and crucial in early diagnosis and intervention.