They have found that my three month old grandchild has a "floppy" voicebox. He had laser surgery 3 days ago to trim down the flaps that were blocking the entrance. There is a concern now that his oxygen saturation level is only 82% and he's not feeding very well. Surely so soon after surgery there would be a certain amount of swelling that could be the cause of the problems or should I be worried?
Person's Gender: Female
Nothing as I am in South Africa and he is in New Zealand. Just need a second opinion
I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping grandparents like you.
You are correct in assuming that there will be some swelling in the area where they removed some of the tissue. I assume he has what is commonly called a "floppy epiglottis" and any time tissue is cut on or even lasered there will be some swelling in the area for a few days. At his age also anesthesia can take some time to wear off and his lungs may still be a bit congested causing his need for oxygen.
I would not be very concerned about his slow recovery considering the trauma to his airway due to the surgery.
And the feeding?
This too because of his difficulty breathing. Once he is off oxygen his appetite should return.
How long should it take to see an improvement to his condition?
They will give him what he needs either through tube feedings (I'm sure he has a tube in his stomach already from the surgery since anyone on oxygen usually has one to keep the stomach from filling with air) or through his IV.
It depends on his general health otherwise: if he is healthy and was eating and growing normally, with normal lungs and no breathing problems before the surgery, then he should recover in the next 2-3 days.
If he was a premature infant with any breathing problems at birth then that generally will cause infants to have some delay in getting off oxygen after surgery of this type.
But this occurs in full term otherwise healthy babies too.
My daughter tried to tell the doctor that there was a problem when he was just 1 month old but they said it was normal. He did cry a lot and didn't want to sleep. At three months he started loosing weight and that's when they found the problem.
Laryngomalacia is a common condition, especially in premature babies, but not readily diagnosed until someone takes a look down the throat at the airway.
It sounds like he was a bit debilitated already then, with the weight loss, and that would also explain his delay in recovering from the surgery. I think given some more time he should improve.
Any chance of brain damage due to the low oxygen saturation levels?
Not as long as the oxygen they are giving him keeps his levels up and even 82% is not harmful, though I'm sure they are keeping him in the mid- to upper 90s.
33 years of experience as a general pediatrician in private practice and in pediatric urgent care.