**Question:** Regarding laryngomalacia - a) Most common cause of stridor in newborn b) Omega-shaped epiglottis c) Inspiratory stridor d) Requires immediate surgery e) Stridor worsens on lying in prone position

**Core Concept:**
Laryngomalacia is a congenital disorder characterized by the collapse of the supraglottal structures during inspiration, leading to stridor and respiratory distress in newborns. It is a relatively common condition, affecting approximately 1 in 500 newborns. The primary pathophysiology involves the floppy and weak cartilaginous structures of the supraglottis, particularly the anterior and posterior arches of the larynx, which prevents proper closure of the airway during inhalation.

**Why the Correct Answer is Right:**
The correct answer is option c) Inspiratory stridor. In laryngomalacia, the primary symptom and sign is inspiratory stridor, which refers to the high-pitched, wheezing sound produced during inhalation. The stridor is typically intermittent and relieved by feeding, swallowing, or crying.

**Why Each Wrong Option is Incorrect:**

a) Most common cause of stridor in newborn: While laryngomalacia can lead to stridor, it is not the most common cause of stridor in newborns. Other causes include subglottic stenosis, tracheomalacia, and foreign bodies.

b) Omega-shaped epiglottis: While it is true that laryngomalacia can result in an omega-shaped epiglottis, this characteristic finding is not the primary cause of stridor in laryngomalacia.

c) Inspiratory stridor: As explained earlier, inspiratory stridor is the primary symptom and sign of laryngomalacia, making this the correct answer.

d) Immediate surgery required: Laryngomalacia typically does not require immediate surgery. Management typically involves conservative measures, such as positioning, feeding, and supportive care.

e) Stridor worsens on lying prone: While it is true that stridor may worsen during prone positioning, this is not a definitive feature of laryngomalacia. Other causes of stridor can worsen as well during this position. Therefore, this statement is not specific enough to confirm laryngomalacia.

**Clinical Pearl:**
In newborns with stridor, a thorough evaluation should include a detailed history and physical examination, as well as further investigations like laryngoscopy and imaging studies if needed. A comprehensive approach helps differentiate between various causes of stridor and guides appropriate management strategies.