Name of the Procedure:

Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn
Common names: Direct Laryngoscopy, Diagnostic Laryngoscopy, Newborn Laryngoscopy

Summary

A direct laryngoscopy is a medical procedure where a doctor uses a special instrument called a laryngoscope to view the newborn’s larynx (voice box) and possibly the trachea (windpipe). This can help diagnose any abnormalities or issues within the airways.

Purpose

This procedure addresses medical conditions such as congenital structural abnormalities, airway obstructions, or breathing difficulties in newborns. The primary goal is to diagnose these problems early on to facilitate timely and appropriate treatment.

Indications

• Stridor (noisy breathing)
• Persistent cough or respiratory distress
• Difficulty swallowing or feeding
• Suspected congenital anomalies of the airway
• Post-intubation evaluation

Preparation

• The newborn may need to fast for a certain period before the procedure.
• Pre-procedure diagnostic tests could include chest X-rays or other imaging studies.
• Parents will be informed of the risks and what steps will be taken during the procedure.

Procedure Description

1. The newborn is positioned securely on the operating table.
2. Anesthesia or sedation may be administered to keep the baby calm and still.
3. The laryngoscope, a thin, lighted tube, is gently inserted through the mouth to visualize the larynx.
4. If tracheoscopy is included, the scope extends into the trachea for further examination.
5. The physician examines the airways for any abnormalities and may take samples or remove obstructions if necessary.
6. The scope is carefully removed once the examination is complete.

Duration

The procedure typically takes 15 to 30 minutes.

Setting

This procedure is usually performed in a hospital setting, either in an operating room or a specialized outpatient clinic.

Personnel

• Pediatric otolaryngologist (ENT specialist)
• Anesthesiologist or nurse anesthetist
• Surgical nurse

Risks and Complications

• Common risks: mild bleeding, temporary swelling of the airway
• Rare risks: infection, airway perforation, adverse reactions to anesthesia
• Complications are managed with medications and close monitoring.

Benefits

• Early and accurate diagnosis of airway problems
• Prompt initiation of treatment plans
• Identification of structural anomalies that might need surgical correction

Recovery

• Post-procedure monitoring in the recovery area for a few hours.
• Pain management: Infants may be given pain relief if needed.
• Parents will receive home care instructions, including feeding guidelines.
• Follow-up appointments to assess healing and discuss further treatment if necessary.

Alternatives

• Indirect laryngoscopy: Involves a mirror or a fiber-optic camera but may not be suitable for newborns.
• Imaging studies: MRI or CT scans, though less direct and potentially less definitive.
• Pros and cons: Direct laryngoscopy provides a more comprehensive and immediate view of the airway compared to non-invasive methods.

Patient Experience

During the procedure, newborns will be under anesthesia or sedation, minimizing discomfort. Afterward, they may experience mild sore throat or temporary hoarseness, which can be managed with appropriate care. Parents should remain observant for any signs of distress and follow provided care instructions diligently.