Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org
Sign in to follow this  
Anna Moscow

Congenital laryngomalacia: clinical approach

Recommended Posts

Hi, Stephan and all the members!

In our unit we ran across the case of congenital laryngomalacia, associated with minor brain abnormalities (cariotype 46XX).

This baby required intubation immediately after birth because of stridor, then was ventilated for 18 days. Several attempts to extubate the baby within 72 hours after birth failed. Our surgeons performed laryngotracheoscopy and the diagnosis of laryngomalacia was established. They recommended 14-day course of prednisolone 1 mg/kg/day for larynx maturation and then repeated extubation. Now baby is 1 month old, spontaneously breathing through ETT. We tried 2 attempts of extub on nCPAP mode, but severe stridor signs occurred and reintubation was needed. The questions are: 1) do steroids really maturate the laryngeal cartilages? If yes what do the indications for repeated course look like? 2) what kind of respiratory support is preferable for this baby? What are the criteria for tracheostomy? 3) If someone had such an experience, what are the possible outcomes?

Thanks for all of you.

Share this post


Link to post
Share on other sites

Well... we would call our ENT consultant and leave most decision-making to him.

I just searched PUBMED and found some nice articles. Actually, tracheomalacia was not a Mesh-term, which I found a little strange, given how common it is. I found nothing on steroids+tracheomalacia.

A qualified guess would be to that the ENT advice would be tracheostomi to get off the ventilator, and while awaiting spontaneous resolution, OR to do some kind of ENT surgery.

Please keep us posted how things develop!

Review: http://www.ncbi.nlm.nih.gov/pubmed/6847290

Laser epiglottopexy: http://www.ncbi.nlm.nih.gov/pubmed/16982974

Aortopexy: http://www.ncbi.nlm.nih.gov/pubmed/16516630

Share this post


Link to post
Share on other sites
Hi, Stephan and all the members!

In our unit we ran across the case of congenital laryngomalacia, associated with minor brain abnormalities (cariotype 46XX).

This baby required intubation immediately after birth because of stridor, then was ventilated for 18 days. Several attempts to extubate the baby within 72 hours after birth failed. Our surgeons performed laryngotracheoscopy and the diagnosis of laryngomalacia was established. They recommended 14-day course of prednisolone 1 mg/kg/day for larynx maturation and then repeated extubation. Now baby is 1 month old, spontaneously breathing through ETT. We tried 2 attempts of extub on nCPAP mode, but severe stridor signs occurred and reintubation was needed. The questions are: 1) do steroids really maturate the laryngeal cartilages? If yes what do the indications for repeated course look like? 2) what kind of respiratory support is preferable for this baby? What are the criteria for tracheostomy? 3) If someone had such an experience, what are the possible outcomes?

Thanks for all of you.

Hi there,

In my experience (and to my knowledge) there are neither cinicial nor scientific data that would support the use of steroids in laryngomalacia.

Though all cases of laryngomalacia improve with time, the time interval is quite long (at least several months) and just waiting is no reasonable approach in patients with the most severe forms needing a tube for maintaining respiration. There are some ENT surgeons that try to stiffen the larynx by laser treatment ("trimming") and we have seen at least two patients in whom tracheostomy has been avoided by this method.

Before considering surgery, however, I would repeat the endoscopy. We have seen several newborns with a prima vista diagnosis of severe laryngomalacia who ultimately went out to have alternative diagnosis (for example vocal cord paralysis (which may be difficult to be diagnosed by an unexperienced observer) or larnygotracheal cleft). Another point ist, that laryngomalacia and tracheomalacia are two totally different entities and treatments for tracheomalacia (e.g. aortopexy) are of no value for laryngomalacia patients.

Would be nice to be informed on the further developemnt of Your patient.

______________________________________________________________________

Norbert Teig, MD

Children's Hospital

Ruhr-University Bochum, Germany

Share this post


Link to post
Share on other sites
...Another point ist, that laryngomalacia and tracheomalacia are two totally different entities and treatments for tracheomalacia (e.g. aortopexy) are of no value for laryngomalacia patients.

Norbert, you're right!

Anna, I'm sorry I did not read your post carefully enough (reading tracheomalacia instead of laryngomalacia, my fault). How are things developing?

Share this post


Link to post
Share on other sites

Dear Stephan and all!

I apologise for a long silence about the clinical case of laryngomalacia. To our regret, the situation haven`t resolve yet: this baby is still intubated and spontaneously breathing through ETT. Additional examination (MRI etc) showed more severe brain abnormalities,than we suspected before, and bilateral blindness. So the prognosis seems to be poor. In Russia there`s a difficulty with performing laryngopexia on routine basis. Two days ago we transferred baby to a special clinic. As I know, they are going to perform tracheostomy.

Share this post


Link to post
Share on other sites

Why don't you try Non invasive ventilation (np CPAP) instead of intubation and may be the baby outgrows the problem in some time..

Regards

Samridh

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Sign in to follow this  

×
×
  • Create New...