Stridor: Why Do Premature Babies Breathe So Noisily?

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August 13, 2024

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Stridor: Why Do Premature Babies Breathe So Noisily?
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Stridor: Why Do Premature Babies Breathe So Noisily?

Both premature and full-term babies have small, narrow airways, which is why they make more noise when breathing. In premature babies, these sounds may be more pronounced due to the immaturity of the respiratory organs. In very premature babies, stridor, a high-pitched or hoarse inhalation sound, is present. What causes stridor? Should you be concerned?

Also read: Feeding a premature baby using the 'cue based feeding' method

What is stridor?

Stridor is a respiratory sound produced mechanically by the airflow passing through an obstruction in the baby's larynx or trachea. It can be high-pitched and musical (like singing) or low-pitched and hoarse (like croaking). Parents often describe it as an animal sound: sheep, goat, rooster, etc.

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Not all sounds babies make necessarily indicate stridor. Newborns often make sounds when they breathe (groaning, grunting, etc.).

Stridor is not a disease but a symptom of partial obstruction of the infant's upper airway. In premature babies, the respiratory system may be underdeveloped, making the airways narrower and more susceptible to obstruction.

Also read: Premature baby's breathing should be stimulated rather than taken over

Causes of stridor in premature babies

Possible causes of stridor in premature babies include:

Laryngomalacia: Laryngomalacia is the most common cause of congenital stridor in premature infants and newborns in general. It occurs within the first few days of life. The sound is caused by the tissues of the larynx being too soft, causing the vocal cords to constrict during inspiration. Affected infants may have a noisy breathing pattern that worsens with feeding, excitement, and crying. Infants feel better when they are lying on their stomachs. However, stridor increases when the baby is lying on his or her back. Gastroesophageal reflux disease (GERD) occurs in 70-80% of infants with laryngomalacia.
Stenosis of the larynx (subglottic stenosis): A narrowing of the lower part of the larynx can lead to stridor. It can be congenital or acquired. In (very) premature babies it can be the result of prolonged intubation.

Other pathologies that may be responsible for stridor: vocal cord paralysis, congenital malformations of the larynx (very rare), angiomas, laryngeal cysts, etc.

Also read: Why and how long should a baby wear a hat?

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https://www.youtube.com/watch?v=/vxORZ2kfzJY

How is stridor treated?

If you suspect that the sounds your premature baby is making are consistent with stridor, contact your pediatrician as soon as possible. He or she can determine the cause of the breathing sounds and, depending on the underlying cause, prescribe treatment.

Laryngomalacia: This condition is benign in most cases and disappears spontaneously. In less than 10% of children, medical or even surgical treatment is necessary. In the case of symptomatic GERD, anti-reflux treatment can be initiated.
Laryngeal stenosis: After endoscopic evaluation, two surgical procedures can be performed: laryngotracheal reconstruction (LTR) and cricotracheal resection (CTR).

Sources:
https://www.paediatrieschweiz.ch/
https://dumas.ccsd.cnrs.fr
https://www.sciencedirect.com
https://www.chuv.ch
https://pubmed.ncbi.nlm.nih.gov

Last updated: December 2023

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