We evaluated 73 consecutively extubated neonates for evidence of acute laryngeal injury from intubation. Hoarseness and stridor were graded by a clinical scoring system. Direct laryngoscopy with a flexible fiberoptic bronchoscope yielded a 44% incidence of moderate or major laryngeal injury. All patients with stridor had moderate or major injury, as did 38% of patients without stridor. Stridor was quite specific for detecting moderate or major injury but did not identify the type of injury.