Supraglottoplasty Outcomes in Children With Down Syndrome

Abstract Objective Children with Down syndrome have a higher incidence of upper airway obstruction and laryngomalacia. We sought to determine outcomes of supraglottoplasty in this patient population. Methods A retrospective chart review was performed from January 2000 through January 2014. Children...

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Published in:	International journal of pediatric otorhinolaryngology Vol. 87; pp. 87 - 90
Main Authors:	Cockerill, Cara C., MD, Frisch, Christopher D., MD, Rein, Sarah E, Orvidas, Laura J., MD
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier Ireland Ltd 01-08-2016
Subjects:	Adenoidectomy Child Child, Preschool Comorbidity Down syndrome Down Syndrome - complications Female Glottis - surgery Humans Infant Laryngomalacia Laryngomalacia - complications Laryngomalacia - diagnosis Laryngomalacia - surgery Male Otolaryngology Pediatrics Respiratory Sounds - etiology Retrospective Studies Supraglottoplasty Tonsillectomy Tracheostomy Treatment Outcome obstructive sleep apnea AHI POD postoperative day laryngomalacia Down syndrome OSA apnea-hypopnea index supraglottoplasty DS Supraglottoplasty Laryngomalacia
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Summary:	Abstract Objective Children with Down syndrome have a higher incidence of upper airway obstruction and laryngomalacia. We sought to determine outcomes of supraglottoplasty in this patient population. Methods A retrospective chart review was performed from January 2000 through January 2014. Children (n=18) at our institution with the diagnosis of Down syndrome who underwent supraglottoplasty were included. We reviewed patient characteristics, preoperative findings, and surgical outcomes (stridor, feeding problems, respiratory distress, weight, sleep apnea, and tracheostomy or feeding tube dependence). Results The average age at surgery was 7.7 months. Operative indications included feeding difficulties (n=9), noisy breathing or respiratory distress (or both) (n=16), and sleep-related symptoms (n=7). Most patients (89%) were extubated successfully on postoperative day 1. There were 2 major complications (CPAP requirement and aspiration pneumonia) deaths. Fifty percent had improved weight (mean=18 percentile points). Feedback was available from 88% of parents with 100% reporting improvement in respiratory symptoms and 93% reporting improved feeding. Eight patients (44%) subsequently required either adenoidectomy or adenotonsillectomy. Two patients later underwent tracheostomy, 2 subsequently needed a gastrostomy tube and 2 required revision supraglottoplasty. Conclusions The majority of children with Down syndrome and laryngomalacia benefit from supraglottoplasty, with outcomes of improved breathing, feeding, and sleeping. However, approximately half may require additional airway procedures. This procedure is well tolerated and associated with a low risk of complications especially given their high rate of comorbidities.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0165-5876 1872-8464
DOI:	10.1016/j.ijporl.2016.05.022