[ case report of severe laryngomalcia, swallowing dysfunction and gastroesophageal reflux in a newborn]

ABSTRACT

Laryngomalacia is the most common cause of stridor between airways malacia in neonates.It can be accompanied by gastroesophageal reflux. Few cases of swallowing dysfunction were reported in neonates with no underlying disorders some of them had laryngomalacia and reflux too. All three causes can lead to neonatal or infantile FTT or recurrent hospitalization. Timely treatment decreased complications of diseases; we reported a case of a newborn that contracted severe laryngomalacia, swallowing dysfunction and gastroesophageal reflux which needed surgery, in order to attract physicians' attention to the aspect and clinical process of these complications, from birth to discharge. Patient was a full term baby boy who was born by normal vaginal delivery without special problem in his fetal status. His parents were not relative. His birth weight was 3100gr and he had appropriate apgar scores, he contracted mild respiratory stridor, subcostal and upper sternal retraction after birth at the delivery room and was referred to NICU. After intubation his signs eliminated, he was intubated several times during the first 2.5 months after birth. He got pneumonia repeatedly and his lung condition improved with reflux treatment. Because of disability in swallowing, milk was gavage for him. But in spite of enough intake calories, he contracted FTT. His respiratory condition improved with tracheostomy in 2.5 months, and gastrostomy was done in 3 months old. He released with a good condition in 100 days old. He was 10 months and his weight was 9kg. Although, it is impossible that laryngomalacia have got signs at birth but it should be concerned as probable cause of respiratory distress in labor room. A report of respiratory distress at birth in company with stridor, disability in milk ingestion, recurrent pneumonia and FTT [without co-existing disease] should get physiscians suspicious of coincident swallowing dysfunction and laryngomalacia. Both two disturbances can be accompanied by gasteroesophageal reflux too. If there was no response to expected medical management, surgical interventions should be necessary