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Hypoxia and hypercapnia in infants with mild laryngomalacia
P B McCray1, D M Crockett, J S Wagener
1Department of Pediatrics, University of Iowa Hospitals, Iowa City 52242.
Insights
Infants with laryngomalacia experience more episodes of hypoxia and hypercapnia, but their risk for serious complications remains low. These breathing events did not correlate with clinical findings in this study.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Sleep Medicine
Background:
- Laryngomalacia is a common cause of stridor in infants.
- Partial upper airway obstruction in laryngomalacia may lead to hypoxia and hypercapnia.
- The clinical significance of these events in infants with laryngomalacia requires further investigation.
Purpose of the Study:
- To evaluate the frequency and severity of hypoxia and hypercapnia in infants with laryngomalacia.
- To determine if clinical history or physical examination can predict these respiratory events.
- To assess the long-term outcomes and complications in infants with laryngomalacia.
Main Methods:
- Continuous overnight monitoring of transcutaneous oxygen pressure and transcutaneous carbon dioxide pressure in 15 infants with laryngomalacia and 12 healthy controls.
- Scoring episodes of hypercapnia and/or hypoxia based on frequency, duration, and relation to activity.
- Clinical follow-up for 2 to 15 months to assess symptoms, growth, and developmental outcomes.
Main Results:
- Infants with laryngomalacia had significantly more frequent episodes of hypoxia and hypercapnia compared to controls.
- The greatest recorded decrease in oxygen saturation was 29 mm Hg and increase in carbon dioxide was 31 mm Hg, both in infants with laryngomalacia.
- Clinical evaluation did not reliably distinguish infants with or without these respiratory events; however, most infants showed symptom improvement or stability with normal growth and development.
Conclusions:
- Infants with laryngomalacia exhibit a higher incidence of hypoxia and hypercapnia episodes.
- Despite increased episodes, the risk of significant complications from these events appears low in this population.
- Clinical assessment is insufficient to identify infants at risk for hypoxia and hypercapnia; monitoring may be necessary for at-risk infants.
Abstract:
We evaluated 15 infants with laryngomalacia and 12 healthy infants to determine their risk of hypoxia and hypercapnia as complications of partial upper airway obstruction. Transcutaneous carbon dioxide pressure and oxygen pressure were recorded continuously overnight with episodes of hypercapnia and/or hypoxia scored for frequency, duration, and relationship to activity. Episodes occurred in 12 infants with laryngomalacia and eight control infants. Infants with laryngomalacia had significantly more episodes. The greatest decrease in transcutaneous oxygen pressure was 29 mm Hg and increase in transcutaneous carbon dioxide pressure was 31 mm Hg, both occurring in infants with laryngomalacia. Three infants had prolonged episodes of hypoxia and hypercapnia. History or physical examination did not distinguish those infants with laryngomalacia who had hypercapnia and/or hypoxia from those without episodes. Two- to 15-month follow-ups in 13 infants with laryngomalacia revealed that symptoms were unchanged or improved. Twelve of these 13 infants had normal growth without developmental delay or other complications. These results demonstrate that episodes of hypoxia and hypercapnia occur more frequently in infants with laryngomalacia than in control infants; however, their apparent risk for complications is low.