Acid Suppression Does Not Improve Laryngomalacia Outcomes but Treatment for Oropharyngeal Dysphagia Might Be Protective.
Acid Suppression Does Not Improve Laryngomalacia Outcomes but Treatment for Oropharyngeal Dysphagia Might Be Protective.
复制标题
DOI：
10.1016/j.jpeds.2021.06.051
复制
发表时间：
2021-11
影响因子：
5.1
通讯作者：
Rosen, Rachel L.
中科院分区：
文献类型：
--
作者：
Duncan, Daniel R.;Larson, Kara;Davidson, Kathryn;Williams, Nina;Liu, Enju;Watters, Karen;Rahbar, Reza;Rosen, Rachel L.
确定抑酸和增稠饲料的使用是否影响婴儿喉软化症的结局，包括声门上成形术风险、声门上成形术时间和住院风险。我们进行了一项回顾性队列研究，以比较2017年1月1日至12月31日期间在波士顿儿童医院诊断为喉软化症的婴儿的声门上成形术风险和时间以及住院频率和持续时间。主要结局为声门上成形术要求、声门上成形术时间和住院风险。进行多变量分析，以确定声门上成形术和住院风险的预测因素，调整喉软化症的严重程度和合并症后，除了倾向评分调整。建立Kaplan-Meier曲线，以确定抑酸对声门上成形术时间的影响。236例平均年龄为62.6±4天的受试者被纳入分析。55%的患者进行了抑酸治疗。抑酸治疗的受试者声门上成形术的风险较高（HR 3.36，95% CI 1.36-8.29，p=0.009），声门上成形术时间更短（5.64±0.92 vs 7.98±1.92个月，p=0.006），呼吸系统住院风险增加（RR 1.97，95% CI 1.01-3.85，0.047），即使在调整协变量后。即使在调整后，接受增厚的受试者的呼吸系统住院天数更少，声门上成形术时间更长（9.3±1.7 vs 4.56±0.73个月，p=0.004）。与未经治疗的受试者相比，抑酸剂的使用不会降低声门上成形术和相关住院的频率。然而，用增稠治疗的患者住院率降低，声门上成形术时间延长，表明增稠饲料可能是优于抑酸的干预措施。
To determine if the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. We performed a retrospective cohort study to compare risk and time to supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children’s Hospital between January 1and 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. 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 higher risk of supraglottoplasty (HR 3.36, 95% CI 1.36–8.29, p=0.009), shorter time to supraglottoplasty (5.64±0.92 vs 7.98±1.92 months, p=0.006), and increased respiratory hospitalization risk (RR 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=0.004), even after adjustment. Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared to 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.
登录
查看更多内容
影响因子：
7.8
作者：
Duncan, Daniel R.;Mitchell, Paul D.;Rosen, Rachel L.
通讯作者：
Rosen, Rachel L.
DOI：
10.1097/mpg.0000000000002167
发表时间：
2019-02-01
影响因子：
2.9
作者：
Duncan, Daniel R.;Larson, Kara;Rosen, Rachel L.
通讯作者：
Rosen, Rachel L.
DOI：
10.1136/archdischild-2016-311286
发表时间：
2017-06-01
影响因子：
1
作者：
Hoskison, E.;Grainger, J.
通讯作者：
Grainger, J.
影响因子：
1.7
作者：
Arslan, Selen Serel;Demir, Numan;Karaduman, Aynur Ayse
通讯作者：
Karaduman, Aynur Ayse
影响因子：
--
作者：
Duncan, Daniel R;Larson, Kara;Rosen, Rachel L
通讯作者：
Rosen, Rachel L