Tracheomalacia

Perhaps more than any other single aspect of care in the acutely ill infant, the management of the airway is the most important determinant of survival or death. The newborn infant has several inherent disadvantages in respiratory mechanics. The diameter of the trachea and bronchi is small; thus the risk of major obstruction is increased. The musculature of the chest wall is relatively weak; thus coughing is less efficient than in older subjects. On the favorable side, however, is the fact that hypoxia is relatively well tolerated. Exchange of gases between the alveolar air sacs and the environment requires an unobstructed tubular passageway, and sufficient intrathoracic negative pressure to draw air into the lungs. Obstruction may occur at several levels and may be congenital or acquired. At the tracheal level, obstruction may result from changes of the tracheal internal lumen, from extrinsic pressure, and as a result of functional tracheal obstruction during the normal respiratory cycle.