RESUMO
OBJECTIVE: To determine whether the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. STUDY DESIGN: We performed a retrospective cohort study to compare risk and time with supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children's Hospital between January 1 and December 31, 2017. The primary outcomes were supraglottoplasty requirement, time to supraglottoplasty, and hospitalization risk. Multivariate analyses were performed to determine predictors of supraglottoplasty and hospitalization risk after adjusting for laryngomalacia severity and comorbidities in addition to propensity score adjustment. Kaplan-Meier curves were created to determine the impact of acid suppression use on time to supraglottoplasty. RESULTS: In total, 236 subjects with mean age 62.6 ± 4 days were included in the analysis; 55% were treated with acid suppression. Subjects treated with acid suppression had a greater risk of supraglottoplasty (hazard ratio 3.36, 95% CI 1.36-8.29, P = .009), shorter time to supraglottoplasty (5.64 ± 0.92 vs 7.98 ± 1.92 months, P = .006), and increased respiratory hospitalization risk (relative risk 1.97, 95% CI 1.01-3.85, 0.047), even after adjustment for covariates. Subjects receiving thickening had fewer respiratory hospitalization nights and longer time to supraglottoplasty (9.3 ± 1.7 vs 4.56 ± 0.73 months, P = .004), even after adjustment. CONCLUSIONS: Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared with untreated subjects. However, patients treated with thickening have decreased hospitalization and longer time to supraglottoplasty, suggesting that thickening of feeds may be a preferred intervention over acid suppression.
Assuntos
Antiulcerosos/administração & dosagem , Transtornos de Deglutição/terapia , Refluxo Gastroesofágico/prevenção & controle , Laringomalácia/complicações , Antiulcerosos/efeitos adversos , Transtornos de Deglutição/etiologia , Feminino , Refluxo Gastroesofágico/etiologia , Glote/cirurgia , Hospitalização , Humanos , Lactente , Laringomalácia/cirurgia , Laringomalácia/terapia , Masculino , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Toda obstrucción de la vía aérea se expresa por un estridor que será diferente según la localización de la obstrucción. El estridor es un ruido ocasionado por el pasaje de aire en forma turbulenta a través de una vía aérea con calibre disminuido. Cuando la obstrucción se ubica por encima de las cuerdas vocales el estridor será inspiratorio. Describimos diferentes patologías de la laringe supraglótica, congénitas y adquiridas, que presentan estridor en algún momento de su evolución.
An obstructed airway causes stridor. Stridor willbe different depending on the location of the obstruction. Stridor is a noise caused by the passage ofturbulent air through a diminished airway caliber. If the obstruction occurs above the vocal cords, itwill be inspiratory. We describe different pathologies of the supraglotticlarynx, both congenital and acquired, producingstridor at some moment of their evolution.
Uma via aérea obstruída provoca estridor. Estridor será diferente dependendo da localização da obstrução. Estridor é um ruído causado pela passagemdo ar turbulento através de uma diminuição do calibre das vias aéreas. Nós descrevemos diferentes patologias da laringe supraglótica, tanto congênitas e adquiridas, que apresentam stridor em algum momento de sua evolução.