Failed intubation in a COVID-positive syndromic neonate

Abstract

Videolaryngoscopy (VL), supraglottic devices (SGDs), and high-flow nasal cannula (HFNC) have been introduced in the algorithms for the management of difficult airway in neonates but dysmorphism in various anatomical sites such as nasopharynx, oropharynx, mandible, maxilla, larynx, trachea, and cervical spine limit the use of the above equipment. We report the airway management in a neonate in which retrognathia, microtia, microstomia, and macroglossia limited visualization of glottis with a VL; cleft palate precluded the use of SGD and choanal atresia precluded the use of HFNC. Concomitant infection with severe acute respiratory syndrome coronavirus 2 necessitated a need to limit repeated airway manipulations. A timely decision in favor of a surgical airway, thus, prevented hypoxia and its related consequences.