Acid Suppression in Mild-Moderate Laryngomalacia Without GERD: A Randomized Controlled Trial

Area of Science:

• Pediatric Gastroenterology
• Otolaryngology
• Neonatology

Background:

• Laryngomalacia is a common congenital condition causing airway obstruction in infants.
• Gastroesophageal reflux (GER) can exacerbate laryngomalacia symptoms.
• Acid suppression therapy (AST) is often used, but its efficacy in this context is debated.

Purpose of the Study:

• To evaluate the effectiveness of acid suppression therapy (AST) in managing gastroesophageal reflux (GER) and airway symptoms in infants diagnosed with mild to moderate laryngomalacia.

Main Methods:

• A randomized controlled trial involving infants (≤6 months) with mild to moderate laryngomalacia.
• Participants were assigned to either AST (famotidine + feeding modifications) or feeding modifications alone.
• Symptom severity was assessed using the Laryngomalacia Airway Symptom Score (LASS) and Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R).

Main Results:

• No significant difference in Laryngomalacia Airway Symptom Score (LASS) or Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R) scores between the AST and no-AST groups.
• Overall improvement in GER and airway symptoms was observed, but not significantly greater with AST.
• Laryngomalacia resolved in 33% of infants, with no significant difference between treatment arms.

Conclusions:

• Acid suppression therapy (AST) does not provide additional benefit for infants with mild to moderate laryngomalacia compared to feeding modifications alone.
• Further research may be needed to identify specific subgroups that could benefit from AST.
• Management should focus on conservative measures like feeding modifications.