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Published on: July 14, 2023
Predicting surgical intervention in infants with laryngomalacia
Robert Brinton Fujiki1, Michael D Puricelli2
1Department of Otolaryngology: Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Infants with severe laryngomalacia symptoms, respiratory illness history, sleep-disordered breathing, or poor suck-swallow-breathe coordination are more likely to need surgery. These factors help predict surgical intervention for laryngomalacia in infants.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Health
- Respiratory Medicine
Background:
- Laryngomalacia is a common congenital condition affecting infant breathing.
- Management decisions hinge on predicting the need for surgical intervention versus conservative monitoring.
- Identifying predictive factors is crucial for optimizing infant outcomes.
Purpose of the Study:
- To examine factors predicting the need for surgical intervention (supraglottoplasty) in infants diagnosed with laryngomalacia.
- To differentiate infants who may benefit from conservative management versus those requiring surgery.
Main Methods:
- Retrospective cohort study of infants diagnosed with laryngomalacia at a tertiary children's hospital.
- Comparison of infants who underwent supraglottoplasty (surgery group) versus those who did not (non-surgery group).
- Data collection included demographics, medical history, symptom severity, comorbidities, and feeding assessments via electronic medical records.
Main Results:
- Severe laryngomalacia symptoms, history of respiratory illness, sleep-disordered breathing, and uncoordinated suck-swallow-breathe patterns significantly predicted the likelihood of supraglottoplasty.
- Infants with severe symptoms were 2.8 times more likely to undergo surgery; those with sleep-disordered breathing were 5.6 times more likely.
- Earlier symptom onset was observed in infants requiring surgical intervention.
Conclusions:
- Symptom severity, respiratory illness history, sleep breathing issues, and impaired suck-swallow-breathe coordination are key predictors for surgical intervention in laryngomalacia.
- These findings can assist clinicians in treatment decisions for infants with mild to moderate laryngomalacia.
Purpose:
Laryngomalacia management involves determining when symptoms can be conservatively monitored and when surgical intervention is necessary to promote weight gain, respiratory function, and overall health. This study examined factors predicting the need for surgical intervention in infants with laryngomalacia.
Methods:
A retrospective cohort design was employed. Infants diagnosed with laryngomalacia were identified from the electronic medical record (EMR) of a tertiary children's hospital. Two groups of infants were identified; those without any history of surgical intervention (non-surgery group = 82) and those who had undergone supraglottoplasty (surgery group = 62). Laryngomalacia diagnosis was determined by pediatric otolaryngologists using distal chip fiberoptic laryngoscopy. Data extracted from the EMR included patient demographics, medical history, laryngomalacia symptoms, comorbidities, swallow assessments, and laryngomalacia-related care information.
Results:
Initial presentation of laryngomalacia symptom severity (p < .001), history of respiratory illness (e.g., pneumonia or respiratory syncytial virus; p < .001), sleep-disordered breathing (p < .001), and an uncoordinated suck-swallow-breathe pattern during feeding (p = .009) significantly predicted likelihood of supraglottoplasty. Likelihood of supraglottoplasty increased 2.8 times in infants with severe laryngomalacia symptoms (p < .001), 5.6 times in patients with sleep-disordered breathing (p < .001), and 2.5 times in those with an uncoordinated suck-swallow-breathe patterns (p < .001) when compared to patients without these conditions. On average, infants requiring supraglottoplasty reported earlier symptom onset than those not requiring surgical intervention (p = .006).
Conclusions:
Surgical intervention in infants with laryngomalacia was predicted by symptom severity, history of respiratory illness, sleep breathing, and suck-swallow-breathe coordination. These data may aid clinicians in determining course of treatment for patients with mild to moderate laryngomalacia.
