Clinical Profile of Neonates with Upper Airway Disease—A Retrospective Study

Introduction Upper airway pathology is an important cause of neonatal respiratory distress, presenting either as acute, life-threatening obstruction requiring immediate intervention or as a chronic, indolent condition, depending on severity and anatomical level. Laryngomalacia is the most common etiology, usually managed conservatively, but sometimes requiring surgery, while high-grade laryngeal clefts pose major therapeutic challenges. This study aimed to evaluate the incidence of laryngoscope-confirmed upper airway pathologies in neonates admitted with suspected airway involvement. Materials and Methods We conducted a retrospective cohort study of neonates admitted to a tertiary neonatal intensive care unit (NICU) over 3 years with suspected upper airway pathology warranting endoscopic evaluation by flexible fiberoptic laryngoscopy (FFL). Descriptive statistics were applied. Cases managed conservatively were followed using the SPECS algorithm (Severity, Progression, Eating difficulty, Cyanosis, Sleep disturbance), with re-evaluation as indicated. Results Of the neonates with respiratory distress, 37 (8.2%) underwent FFL for suspected airway pathology. Twelve (32%) had bedside procedures, while 25 (68%) underwent evaluation in the operating theater (OT). The median procedure time was 15 min (range 10-30), with no reported complications. The most frequent diagnoses were laryngomalacia (24.3%), subglottic stenosis (13.5%), and laryngeal cleft (8%). Among laryngomalacia cases, 67% required surgical correction. Conclusion Flexible airway endoscopy is a safe and effective diagnostic tool for neonatal airway obstruction and should be employed in all cases of suspected pathology to identify correctable causes. Laryngomalacia emerged as the most prevalent condition, frequently requiring intervention.