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Laryngomalacia in Neonates Versus Older Infants: HCUP-KID Perspective
Michele M Carr1, Jad Ramadan2, Emma Bauer2
1University at Buffalo, Buffalo, NY, USA.
Insights
Neonates diagnosed with laryngomalacia (LM) face higher mortality and resource utilization. Policies should mandate laryngoscopy before diagnosing LM in newborns to ensure accurate assessment and care.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Critical Care
- Healthcare Informatics
Background:
- Laryngomalacia (LM) is a common congenital condition affecting infants.
- Hospital course and outcomes for neonates with LM require further evaluation.
- Existing data may not adequately differentiate neonatal and older infant LM hospitalizations.
Purpose of the Study:
- To compare the hospital course of neonates and older infants diagnosed with laryngomalacia.
- To identify disparities in mortality, resource utilization, and diagnostic procedures.
- To inform policy recommendations for the diagnosis of LM in neonates.
Main Methods:
- Retrospective analysis of the 2016 Kids' Inpatient Database.
- Identification of 6537 infants (<1 year) with laryngomalacia (ICD-10 Q31.5).
- Comparison of outcomes between neonates (n=2212) and non-neonates (n=4325).
Main Results:
- Neonates exhibited higher mortality (1.31% vs 0.72%), more diagnoses (median 9 vs 7), and significantly higher charges (median $65,722 vs $25,582).
- Neonates had longer hospital stays (median 10 vs 4 days) and underwent fewer laryngoscopies (23.3%) despite diagnosis.
- Second airway lesions were noted in 12.33% of neonates and 15.77% of older infants.
Conclusions:
- Neonates with laryngomalacia experience a more severe hospital course compared to older infants.
- A significant proportion of neonates are diagnosed with LM without direct laryngeal visualization.
- Recommendations include implementing policies for mandatory laryngoscopy in neonates before LM diagnosis.
Abstract:
This study evaluated the hospital course for neonates and older infants with a diagnosis of laryngomalacia (LM). Data came from the 2016 Kids' Inpatient Database of the Healthcare Cost Utilization Project. A total of 6537 children aged <1 year with a diagnosis of LM (International Classification of Diseases, 10th Revision, code Q31.5) were identified: 2212 neonates and 4325 non-neonates. Neonates had a higher mortality rate, 1.31% versus 0.72% in older infants, had more diagnoses (median 9 vs 7) and procedures (mean 85.24 vs 21.83), longer length of stay (median 10 vs 4 days), and higher total charges (median US$65 722 vs US$25 582). A total of 23.3% of neonates born during the admission and diagnosed with LM had undergone laryngoscopy. Second airway lesions were present in 12.33% of neonates and 15.77% of older infants. It appears that neonates are being discharged with a diagnosis of LM without laryngoscopy. Neonatal intensive care unit and newborn nursery policies should require visualization of the larynx prior to diagnosis of LM.
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