2020A07 Describe the anatomy of the neonatal airway, and what implications this has for airway management.



·        Upper airway

·        Lower airway

·        Other


Upper airway:

Narrow upper airways:

·   Narrow nasal passages

·   Large tongue

·   Narrow pharynx


·   ↑ Resistance. Provides auto-PEEP

·   Guedel airway useful during mask ventilation

Obligate nose breather because of

·     Large tongue

·     High laryngeal inlet (C3-4 cf. C6)

·   Any nasal obstruction = dangerous

Prominent occiput:

·   Tendency for flexion -> obstruction

·   Folded towel under shoulders for bag-mask vent and intubation



Lower airways:

Narrower lower airways

·   Includes larynx, trachea and bronchi
Resistance 25cmH2O/L/s on day 2

·   Note narrowest point cricoid ring (cf. glottis in adults)


·   Any further obstruction = dangerous

·   Risk of subglottic stenosis with prolonged intubation

·   Epiglottis long, U shape, floppy

·   Can be bypassed using straight bladed laryngoscope (Miller)

·   Risk of glottic obstruction by misplaced LMA

·   Laryngeal inlet is high C3-4 and anterior

·   Larynx

·   Different intubation mechanics

·   Short trachea

·   Risk of endobronchial intubation during neck flexion

·   Risk of accidental extubation during neck extension




Risk of oxygen toxicity

·   Bronchopulmonary dysplasia

·   (Other: retinopathy of prematurity, necrotising enterocolitis)

Non-respiratory functions

·   Innate immunity e.g. mucocilicary escalator present in neonate and adult

·   Adaptive immunity: passive (from breast milk) vs endogenous. No endogenous IgG or IgA in neonatal alveolar lining fluid



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