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Pediatrics & Neonatal Healthcare 2017
September 11-12, 2017 Los Angeles, CA, USA
14th World Pediatrics &
Neonatal Healthcare Conference
Journal of Pediatric Health Care and Medicine Volume 1, Issue 1
Notes:
Post-operative stridor following repair of tracheoesophageal fistula: A case report
Showkat Hussain Tali
AIMSR, India
Afull term, male infant with no significant antenatal and birth history developed severe respiratory distress on
day 2 of life. Infant was diagnosed to have H-type of tracheoesopheageal fistula (TEF) and was operated for
the same on day 4 of life. Infant was extubated on day 20 of life (difficult extubation) and was put on HHHFNC
(heated humidified high flow nasal cannula). Soon after extubation, infant developed severe respiratory distress
and stridor. Infant was put back under ventilator support. Flexible laryngoscopy along with bronchoscopy was
performed under light sedation. Except for mild subglotic edema, no abnormality was detected. Size 3.5 ET
(endotracheal) tube was replaced with a 3 size ET tube and a short course of dexamethasone (0.2 mg/kg/day
× 5 days) was administered. After a 10 days period, the infant could be weaned to CPAP (continuous positive
airway pressure). However it was not possible to take the infant off the CPAP thereafter. CECT (contrast
enhanced computed tomography) was performed and no significant abnormality was detected. Parents were
counseled for a tracheostomy but they refused. After one month period, when there was no improvement in
clinical condition, laryngoscopy with bronchoscopy was again performed under anesthesia. Tight aryepiglotic
folds were detected and aryepiglotic split was performed. Infant responded dramatically to treatment and could
be weaned to room air within 3 days of surgery. The anesthesia technique has been found to be superior to
awake technique with a sensitivity, specificity, positive predictive value and negative predictive value of 100%
each as compared with 93%, 92%, 97%, and 79%, respectively, for awake technique. Most probably, we missed
the diagnoses in the first place as we didn’t perform the laryngoscopy under anesthesia or sufficient sedation.
It is worth mentioning that laryngoscopy along with bronchoscopy and esophagoscopy was performed under
anesthesia during the initial evaluation of TEF before surgery. This makes us strongly believe that the tight
aryepiglotic folds were a complication of TEF repair surgery or prolonged intubation rather than a congenital
one.
Biography
Showkat Hussain Tali is working as Assistant Professor Pediatrics, Adesh University. After obtaining his Bachelor’s degree in 2005, he obtained his MD in
Pediatric Medicine from University of Kashmir in 2010. In 2013 he joined Department of Neonatology at Surya Children’s Hospital, Mumbai and became
Board Certified in Neonatology from the National Board of India in 2016. In the same year, he joined Adesh University as Assistant Professor Pediatrics and
In-charge Neonatology. He has more than a dozen publications in national and international journals. He has received Science Talent Search Award from the
Govt. of Jammu and Kashmir in 1997 and has been awarded by Help Foundation and Rajiv Gandhi Foundation, India, for excellence in creative writing in
2007. On May 26/2017, he presented a speech at International Congress of Gynecology and Obstetrics, Prague, Czech Republic and has been invited to deliver
speech at International Congress of Pediatrics, Taiyuan China (Nov 2017).