Laryngomalacia Flashcards
What is the most common cause of stridor in a neonate?
Laryngomalacia - causes stridor in approximately 50% of neonate cases
Other causes of stridor not in neonates:
- Croup usually affects children aged 6 months - 3 years
- Epiglottitis has almost been eliminated since the introduction of the H. influenza vaccine but it typically causes stridor in children aged 2-4 yrs
- Bronchiolitis commonly affects individuals aged 3-6 months
What is the pathophysiology of laryngomalacia?
Congenital abnormality of the lanrynx
What is the epidemiology of laryngomalacia?
M> F (2:1)
Up to 40% can have an associated condition/syndrome
What is the typical presentation of laryngomalacia?
Stridor in an infant < 4 weeks old but not present at birth - worse when the child is active, crying, or feeding, and is more apparent when supine
What is the management of laryngomalacia?
Mild LM: audible stridor and endoscopic features of LM, but no respiratory distress and no evidence of failure to thrive (i.e., steady growth on weight centile charts). Feeding difficulties and reflux can be managed conservatively. Reassure that this will self resolve.
Moderate LM: as above but w/ increased work of breathing, progressive feeding difficulties, and inadequate weight gain. A conservative approach w/ regular review OR endoscopic supraglottoplasty if severe breathing difficulties/feeding difficulties.
Severe LM: significant shortness of breath and airway obstruction, failure to thrive, marked dysphagia, associated apnoeas, hypoxia or hypercapnia, pulmonary hypertension, cor pulmonale, delayed neuropsychomotor development, obstructive sleep apnoea, or severe chest deformity (pectus excavatum). Endoscopic supraglottoplasty .
What is the prognosis of mild laryngomalacia?
Gradual, spontaneous resolution by 2 years of age, unless there is a neurological condition contributing to poor laryngeal tone
