Stridor in infants with hypoxic-ischemic encephalopathy and whole body hypothermia: A case series


BACKGROUND: Stridor is one of the rare side effects of neonatal hypothermia treatment for hypoxic-ischemic encephalopathy. We aimed to describe the clinical characteristics of the infants who underwent whole-body hypothermia and developed stridor.

METHODS: We reviewed the medical records of 171 infants with moderate or severe hypoxic-ischemic encephalopathy who underwent hypothermia therapy. Demographics, as well as clinical characteristics, were documented.

RESULTS: A total of 18 infants developed transient stridor out of 171 infants who underwent whole-body hypothermia (10.5%). The stridor was transient and resolved in all infants. All infants with stridor received treatment with one or more of the following: racemic epinephrine, dexamethasone, positive pressure ventilation and/or heliox. Two infants required otorhinolaryngologist (ENT) evaluation due to persistent and severe symptoms, of whom one was found to have left vocal cord paresis that improved with time.

CONCLUSION: Stridor is a transient complication associated with hypoxic-ischemic encephalopathy and whole-body hypothermia in neonates. The exact mechanism is unclear and most likely multifactorial. ENT evaluation is recommended in the presence of prolonged symptoms or significant respiratory distress.

*Corresponding Author: 

Mahdi Alsaleem MD, Department of Pediatrics, Division of Neonatology, Children’s Mercy Hospital. Assistant Professor at University of Kansas 2401 Gillham Rd. Kansas City, MO 64108 Phone: +816 234 3981; Fax: +816 302 9987; E-mail: