Predicting surgical intervention in infants with 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.