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Pharyngomalacia diagnosed by laryngo-tracheo-bronchoscopy in the neonatal intensive care unit
Masanori Wasa1, Hisaya Hasegawa1, Yosuke Yamada1
1Department of Neonatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Insights
Pharyngomalacia, a common infant airway disease, often co-occurs with other conditions like laryngomalacia. Careful observation of the pharyngeal space is crucial for diagnosing this inspiratory occlusion in infants.
Area of Science:
- Pediatric Pulmonology
- Neonatal Care
- Airway Disorders
Background:
- Flexible fiber-optic laryngo-tracheo-bronchoscopy is a common procedure in infants.
- Laryngomalacia is the most frequent infant airway disease causing stridor.
- Pharyngomalacia, or pharyngeal occlusion during inspiration, is the second most common airway disease in infants undergoing bronchoscopy, but lacks extensive reporting in Japan.
Purpose of the Study:
- To report the incidence, patient characteristics, and natural course of pharyngomalacia in Japanese infants.
- To analyze concurrent airway diseases, comorbidities, and treatments for pharyngomalacia.
Main Methods:
- Retrospective review of medical records for infants diagnosed with pharyngomalacia between April 2009 and November 2018.
- Analysis of patient demographics, gestational age, birth weight, diagnosis age, and resolution age.
- Review of concurrent airway diseases, comorbidities, and interventions such as CPAP or HFNC.
Main Results:
- Forty-eight infants were diagnosed with pharyngomalacia.
- Median gestational age was 37.1 weeks; median birth weight was 2,552g.
- Diagnosis occurred at a median of 29 days, with resolution by 4 months. 28 patients had concurrent airway diseases, most commonly laryngomalacia. 34 patients received CPAP or HFNC.
Conclusions:
- Pharyngomalacia affects infants, with half born preterm and over half having concurrent airway diseases.
- Onset and diagnosis typically occur within the first month of life, with resolution usually within six months.
- Careful observation of the pharyngeal space is recommended for diagnosing pharyngomalacia in infants suspected of airway disease.
Background:
Flexible fiber-optic laryngo-tracheo-bronchoscopy has become widely performed in infants and neonates since the introduction of thin flexible fiberscopes. Laryngomalacia is the most common airway disease in infants causing stridor. Pharyngomalacia, termed pharyngeal occlusion during inspiration, was the second most common airway disease found in our hospital in patients that underwent laryngo-tracheo-bronchoscopy, but the incidence, patient characteristics, and natural course have not been reported in large numbers in Japan.
Methods:
A retrospective review was performed of medical records on patients admitted to our neonatal intensive care unit during the neonatal period diagnosed with pharyngomalacia between April 2009 and November 2018. Patient characteristics, concurrent airway diseases, comorbidities, and treatment were reviewed.
Results:
Forty-eight patients were diagnosed with pharyngomalacia. The median gestational age was 37.1 weeks, and the median birthweight was 2,552 g. Patients were diagnosed at a median age of 29 days, and cure was achieved at a median age of 4 months. Twenty-eight patients had concurrent airway diseases, laryngomalacia being the most common. Continuous positive airway pressure or high flow nasal cannula was used in 34 patients.
Conclusions:
In patients with pharyngomalacia, half were born preterm, and more than half had concurrent airway diseases. The onset and diagnosis were made within the first month of life in more than half of the patients, and resolution was seen mostly within the first 6 months of life. Whenever a patient is suspected of having an airway disease, the pharyngeal space should be carefully observed to diagnose pharyngomalacia.
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