John Drew Prosser, James Arthur Norton, Jack Calvin Borders, Anjum Naveed.
Predictors of Outcomes Following KTP Laser Supraglottoplasty for Severe Laryngomalacia.
Pak J Otolaryngol Jan ;30(1):15-7.

INTRODUCTION: Laryngomalacia is the most common cause of infant stridor. The majority of cases are self-limited but up to 20% of patients require surgical intervention secondary to severe airway obstruction or poor weight-gain. PATIENTS AND METHODS: IRB approved, retrospective study in a tertiary care children's hospital was planned . to determine what factors predict short-term (in-hospital) and long-term (out patient follow-up) success following laser supraglottoplasty for severe laryngomalacia. RESULTS: 31 children underwent laser supraglottoplasty from Feb 2009-Sept 2010. Co-morbidities included gastro-oesophageal reflux disease GERD (58%), prematurity (32%), neurologic (13%), cardiac (13%), and synchronous airway lesions SALs (23%). Age <2 months was associated with lower cure rates (71% vs 100%, p=0.0285), but not longer hospital stays or more non-invasive ventilatory support (NIV). Children with neurologic comorbidities required a longer duration (57 vs 5 hours, p<0.0001) of NIV and longer stays (3.5 vs 1.19 days, p<0.0001). GERD was not associated with more NIV or worse cure rates. Children with cardiac comorbidities tended to have longer inpatient stays but this did not reach statistical significance (p=0.076). Children with SALs had longer inpatient stays (2.57 vs 1.16 days, p<0.0001) and required more NIV (33.1 vs 5.5 hours, p=0.002). They were also more likely to receive Heliox (p=0.05). Prematurity trended patients toward longer hospital stays, more NIV and lower cure rates (p=0.08, 0.11, and 0.19 respectively). Complication rates were 12.9 percent. CONCULSION: This study confirms that primary laser supraglottoplasty has a high success rate (90.3%). Patients with neurologic comorbidities and SALs have longer hospital stays and require more inpatient support. Age < 2 months is associated with lower cure rates.

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