From the Guidelines
Laryngomalacia is strongly associated with prematurity, low birth weight, neurological disorders, gastroesophageal reflux disease (GERD), and certain genetic syndromes, which are considered predictive risk factors for this condition. These factors can contribute to the development of laryngomalacia, a condition characterized by the collapse of the laryngeal cartilage during inspiration, leading to airway obstruction. According to the most recent study 1, airway anomalies, including laryngomalacia, occur in approximately 20% of children with 22q11.2 deletion syndrome, highlighting the importance of genetic syndromes as a risk factor.
Predictive Risk Factors
- Prematurity
- Low birth weight
- Neurological disorders (particularly cerebral palsy and hypotonia)
- Gastroesophageal reflux disease (GERD)
- Certain genetic syndromes (such as Down syndrome, Pierre Robin sequence, and 22q11.2 deletion syndrome)
- Anatomical factors like micrognathia (small jaw) and retrognathia (recessed jaw)
Clinical Presentation and Management
Laryngomalacia typically presents within the first few weeks of life with inspiratory stridor that worsens with feeding, crying, or supine positioning. While most cases resolve spontaneously by 12-24 months of age, severe cases may require surgical intervention such as supraglottoplasty. Monitoring for complications is essential, as infants with laryngomalacia may develop feeding difficulties, failure to thrive, obstructive sleep apnea, or respiratory distress. Treatment of coexisting conditions, particularly GERD, with medications like infant-appropriate doses of proton pump inhibitors, may improve symptoms, as suggested by 1.
Importance of Early Detection and Management
Early detection and management of laryngomalacia are crucial to prevent long-term complications and improve the quality of life for affected infants. The underlying pathophysiology involves immature or hypotonic laryngeal cartilage that collapses during inspiration, creating airway obstruction. Therefore, it is essential to prioritize the management of predictive risk factors and coexisting conditions to improve outcomes in infants with laryngomalacia, as supported by the latest clinical practice recommendations 1.
From the Research
Predictive Risk Factors for Laryngomalacia
The predictive risk factors for laryngomalacia include:
- Low APGAR scores 2
- Low resting SAO2 level at time of presentation 2
- Presence of a secondary airway lesion 3, 2
- Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) 2, 4
- Medical co-morbidities such as neurologic disease, congenital heart disease, a genetic syndrome, or anomaly 2, 4
- Presence of multiple medical co-morbidities, which can additively affect surgical outcomes 2
Disease Severity and Outcomes
Factors that influence disease severity and outcomes include:
- Presence of feeding symptoms or severe airway obstruction 5, 2
- Presence of medical co-morbidities, which can worsen symptoms and affect surgical outcomes 2, 4
- Presence of an additional level of airway obstruction, which can increase the risk of requiring surgical intervention 4
- Response to acid suppression therapy, which can improve symptoms in infants with GERD/LPR 2, 4
Surgical Intervention
Surgical intervention, such as supraglottoplasty, may be required in severe cases of laryngomalacia, particularly in infants with: