and agitation), CO2 retention or aspiration, and placed on continuous pulse oximetry and oxygen to maintain saturations above 95% Blood gas to assess ventilation should also be considered Those with significant stridor may need respiratory support (high-flow humidified nasal cannula, continuous positive airway pressure [CPAP], or intubation and mechanical ventilation) If the airway is unstable, there should be appropriate equipment and personnel experienced in management of a neonatal airway The neonatal larynx has multiple features that are different from that of older children These predispose neonates to very rapid deterioration in respiratory status and can make endotracheal intubation challenging In addition to the smaller size, less than one-third of the adult size larynx, the position of the larynx at birth is higher (C4 rather than C7 in children) The epiglottis is longer and omega shaped Lastly, the cartilage is softer than that of older children, which is thought to contribute to the collapsibility of the laryngeal airway Additionally, neonates have very low respiratory reserve and high vagal tone; each intubation attempt should be preceded by preoxygenation and should not last longer than 30 seconds Vagolytics such as atropine should be given prior to intubation to prevent reflex bradycardia and promote cardiac stability Obtaining an airway film may help in differentiating etiology (e.g., subglottic stenosis, retropharyngeal abscess, soft tissue tumors compressing airway, or congenital cysts) A chest radiograph may also help if there is a suspected pulmonary component Obtaining a blood gas (if possible) helps with assessment of hypoxia and carbon dioxide retention All newborns with respiratory instability should be admitted to an intensive care unit In newborns with significant airway anomalies, surgical consultation is indicated Chapter 75 Stridor , further discusses the diagnosis and management of children with stridor CLINICAL PEARLS AND PITFALLS