A 6-week-old has inspiratory stridor, suprasternal recession, oxygen desaturations and faltering growth. Flexible laryngoscopy shows shortened aryepiglottic folds and inspiratory supraglottic collapse. What is the best management?
Severity is determined by physiology and feeding/growth, not noise alone; supraglottoplasty is appropriate after evaluation for multilevel disease.
A. Reassurance alone because all laryngomalacia resolves: Hypoxaemia and growth failure define severe disease.
B. Microlaryngobronchoscopy to exclude synchronous lesions and supraglottoplasty in an experienced paediatric airway service: Severe symptomatic laryngomalacia warrants full airway assessment and surgical relief; feeding and comorbidity assessment are integral.
C. Adenoidectomy: Adenoids do not cause neonatal dynamic supraglottic collapse.
D. Blind nasogastric feeding without airway assessment: Nutrition support may be needed but does not correct critical obstruction.
E. Long-term antibiotics: There is no bacterial process.
If the infant fed and grew normally without recession or desaturation, observation with safety-netting would usually be preferred.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, or a substitute for local policy and specialist clinical judgement.
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