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Difficult intubation in a neonate: a diagnostic dilemma
  1. Pankaj Kumar Mohanty1,
  2. Tapas Kumar Som1,
  3. Suvendu Purkait2 and
  4. Amit Kumar Satapathy3
  1. 1 Neonatology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
  2. 2 Pathology, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
  3. 3 Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
  1. Correspondence to Dr Pankaj Kumar Mohanty, drpankajpaeds{at}, neonat_pankaj{at}


Difficult intubation in neonates has innumerable aetiologies. It especially poses a formidable challenge to save a newborn baby immediately after birth where antenatal details are unavailable. A late preterm neonate was born limp and apnoeic. Several attempts to intubate the baby were unsuccessful. Possibility of subglottic obstruction was considered. The baby died of severe perinatal asphyxia. Autopsy showed a mass around the airway which turned out to be ectopic thymus on histopathology. Ectopic thymus can present as periglottic mass without externally visible cervical swelling and can cause difficult intubation which may lead to serious adverse outcome including death if not anticipated early and managed accordingly.

  • neonatal intensive care
  • congenital disorders
  • neonatal health

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  • Contributors PKM and TKS wrote the manuscript. SP did the autopsy and AKS revised the manuscript and added valuable points. All authors finally accepted the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.