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Initiation of Acid Suppression Therapy Prospective Outcomes for Laryngomalacia

Primary Purpose

Laryngomalacia, Gastro Esophageal Reflux

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
Famotidine
Speech Language Therapy
Sponsored by
Reema Padia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Laryngomalacia focused on measuring Laryngomalacia, Symptom improvement, Famotidine, Speech Language Therapy

Eligibility Criteria

0 Months - 6 Months (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Pediatric patients ages 0 to 6 months who do need meet the criteria at the initial appointment for supraglottoplasty
  • Seen in University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh (CHP) Otolaryngology Department
  • Laryngomalacia without prolonged (>20 seconds) cyanosis, apnea, nor failure to thrive.

Exclusion Criteria:

  • Children over the age of 6 months old will be excluded from participation.
  • Premature infants (<37 weeks gestation)
  • Patients with lung disease.
  • Laryngomalacia with prolonged (>20 seconds) cyanosis, apnea, and failure to thrive
  • Sleep induced laryngomalacia
  • Patients with craniofacial abnormalities
  • Patients with a syndrome
  • Patients with additional airway abnormalities, seen before or at consult
  • Patients with symptoms that necessitate surgery
  • Patients with a prior cardiac surgery
  • Patients with AST prescribed prior to the initial otolaryngology consult.

Sites / Locations

  • UPMC Children's Hospital of PittsburghRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Speech Language Therapy Alone

Speech Language Therapy and Acid Suppression Therapy

Arm Description

Patients in this group will receive a routine swallowing evaluation by a speech language pathologist. Patient caregivers will fill out the Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) and the Pittsburgh Airway Symptom Score (PASS) the day of the appointment and at the 3-month follow up appointment.

Patients in this group will receive a routine swallowing evaluation by a speech language pathologist and famotidine (acid suppression therapy). Patient caregivers will fill out the Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) and the Pittsburgh Airway Symptom Score (PASS) the day of the appointment and at the 3-month follow up appointment.

Outcomes

Primary Outcome Measures

Airway symptom score change from consult (baseline) to 3 month follow-up appointment
Score change from pre to post surveys on the Pittsburgh Airway Symptom Score (PASS) questionnaire. The PASS is on a scale from 0-10 with a higher score indicating a worse outcome. This outcome will be assessed at the consult and the 3 month follow-up appointment.
Dysphagia symptom score change from consult (baseline) to 3 month follow-up appointment
Score change from pre to post surveys on the Pittsburgh Airway Symptom Score (PASS) questionnaire. The PASS is on a scale from 0-10 with a higher score indicating a worse outcome. This outcome will be assessed at the consult and the 3 month follow-up appointment.
Change in incidence of airway symptoms from consult up to 1 year assessed via electronic medical chart review
Change in incidence of airway symptoms from consult up to 1 year assessed via electronic medical chart review. Notes from the Department of Otolaryngology will be reviewed which include reported symptoms from caregivers and symptoms seen upon exam. Airway symptoms included periods of apnea, chest wall retractions, cyanosis, stridor, noisy breathing, and increased respiratory rate.
Change in incidence of dysphagia symptoms from consult up to 1 year assessed via electronic medical chart
Change in incidence of dysphagia symptoms from consult up to 1 year assessed via electronic medical chart review. Notes from the Department of Otolaryngology will be reviewed which include reported symptoms from caregivers and symptoms seen upon exam. Dysphagia symptoms included choking, coughing, gagging with feeds and/or emesis after feeds.

Secondary Outcome Measures

Weight (kg) from consult up to 1 year
Weight change in kilograms assessed from medical chart review from consult up to 1 year
Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) score change from consult (baseline) to 3 month follow-up appointment
Score change from pre to post survey on the I-GERQ-R. There are 12 questions on the surveys on a scale of 0-42. A higher score indicates a worse outcome. Those with a score of >=16 on this survey at the initial consult are excluded from the study, indicating true gastroesophageal reflux disease (GERD). This outcome will be assessed at the consult and the 3 month follow-up appointment.
Number of participants with the need for supraglottoplasty surgery (escalation of treatment) up to 1 year
The need for escalation of treatment with supraglottoplasty surgery will be assessed through medical chart review up to 1 year.
Number of participants with the need for acid suppression therapy medication (famotidine) from speech language therapy alone group from the day after the consult up to the 3 month follow up appointment
The speech language therapy alone group will be assessed for the need for a prescription for acid suppression therapy (famotidine) from the day after the consult up to 1 year.
Number of participants with each type of laryngomalacia (Types 1-3) found on the Flexible Laryngoscopy procedure at the consult
All patients will be scoped with a flexible laryngoscopy at the initial consult and the type of laryngomalacia (Types 1-3) will be noted.
Number of participants with the need for a different acid suppression therapy medication (other than famotidine) from the day after the consult up to the 3 month follow up appointment
Both groups will be assessed for the need for a different acid suppression therapy medication (other than famotidine) from the day after the consult up to the 3 month follow up appointment.

Full Information

First Posted
October 22, 2020
Last Updated
May 1, 2023
Sponsor
Reema Padia
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1. Study Identification

Unique Protocol Identification Number
NCT04614974
Brief Title
Initiation of Acid Suppression Therapy Prospective Outcomes for Laryngomalacia
Official Title
Initiation of Acid Suppression Therapy Prospective Outcomes for Laryngomalacia
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 18, 2020 (Actual)
Primary Completion Date
December 31, 2023 (Anticipated)
Study Completion Date
March 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Reema Padia

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Laryngomalacia (LM) is the most common cause of stridor in infants. Symptoms of gastroesophageal reflux (GER) are often seen in the setting of LM; therefore, acid suppression therapy (AST) has been empirically used in the management of this disorder. The investigators recently performed a retrospective chart review assessing improvement of airway and dysphagia symptoms, weight gain, and need for surgery with AST. It was found that there was a similar improvement between LM severity groups and most patients received AST (96.6%). It is unclear if these improvements are due to AST or natural resolution of the disease. With heightened concerns of side effects related to AST in infants, particularly among those born prematurely, judicious use of these medications is needed. The investigators are now performing a prospective study looking at the outcome differences in patients with laryngomalacia who are evaluated by speech language therapy (SLP) alone versus those with SLP evaluation and acid suppression therapy (famotidine).
Detailed Description
Purpose: To determine the outcome differences in patients 6 months and younger with laryngomalacia and dysphagia who are evaluated by speech language therapy (SLP) alone versus those with both SLP evaluation and acid suppression therapy (AST) (famotidine) Hypothesis: There will be no differences in outcomes between those that had SLP alone versus those that had both SLP and AST. Laryngomalacia (LM) is the most common cause of stridor in infants. Symptoms of gastroesophageal reflux (GER) are often seen in the setting of LM; therefore, acid suppression therapy (AST) has been empirically used in the management of this disorder. However, there is no gold standard in treating mild and moderate LM patients and therefore this study will help establish guidelines for treatment. A medical chart review will be performed to assess airway and dysphagia symptom improvement from consult to the 3-month follow up appointment and then up to a year. The Pittsburgh Airway Symptom Score (PASS) questionnaire and the Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) will be given to families at the consult and at the 3-month follow up appointment for caregiver assessment. The physician will then perform the standard procedures at the clinic appointment. The Flexible Laryngoscopy Findings sheet will be filled out in conjunction with the clinic procedures for objective data. The surveys will then be scored to determine true GERD (score >=16) and severe laryngomalacia (LM) (RED questions on the PASS), which would further exclude these patients. There are 12 total questions on the I-GERQ-R. On the PASS, questions 1 & 2 are in the GREEN category and signifies mild LM, YELLOW signifies moderate LM, and RED is severe LM. On the PASS questionnaire, "Yes" to either #1 or #2 and nothing else is mild LM, "yes" to at least one #3-5 and none of #6-10 is moderate LM, and "yes" to any of the #6-10" indicates severe LM. There are 10 total questions on the PASS. Mild and moderate LM patients will be block randomized the day before the appointment to receive speech language therapy alone or speech language therapy with famotidine (Pepcid). Both treatments are standard of care in these patients. Speech language therapy (feeding therapy) is part of the normal clinic visit for LM patients. These patients will then be re-evaluated at their follow up appointment in 3 months (+/- 1 month). The families will take the PASS and I-GERQ-R surveys again to determine LM severity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Laryngomalacia, Gastro Esophageal Reflux
Keywords
Laryngomalacia, Symptom improvement, Famotidine, Speech Language Therapy

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Experimental, open-label randomized control trial
Masking
None (Open Label)
Masking Description
Open Label
Allocation
Randomized
Enrollment
160 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Speech Language Therapy Alone
Arm Type
Experimental
Arm Description
Patients in this group will receive a routine swallowing evaluation by a speech language pathologist. Patient caregivers will fill out the Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) and the Pittsburgh Airway Symptom Score (PASS) the day of the appointment and at the 3-month follow up appointment.
Arm Title
Speech Language Therapy and Acid Suppression Therapy
Arm Type
Active Comparator
Arm Description
Patients in this group will receive a routine swallowing evaluation by a speech language pathologist and famotidine (acid suppression therapy). Patient caregivers will fill out the Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) and the Pittsburgh Airway Symptom Score (PASS) the day of the appointment and at the 3-month follow up appointment.
Intervention Type
Drug
Intervention Name(s)
Famotidine
Intervention Description
Famotidine will be prescribed based on patients' weight. Caregivers will purchase this medication and dosage will be given to families in easy-to-understand language.
Intervention Type
Other
Intervention Name(s)
Speech Language Therapy
Intervention Description
Speech Language Therapy (feeding therapy) will be provided by a speech language pathologist to assess feeding and swallowing.
Primary Outcome Measure Information:
Title
Airway symptom score change from consult (baseline) to 3 month follow-up appointment
Description
Score change from pre to post surveys on the Pittsburgh Airway Symptom Score (PASS) questionnaire. The PASS is on a scale from 0-10 with a higher score indicating a worse outcome. This outcome will be assessed at the consult and the 3 month follow-up appointment.
Time Frame
3 months
Title
Dysphagia symptom score change from consult (baseline) to 3 month follow-up appointment
Description
Score change from pre to post surveys on the Pittsburgh Airway Symptom Score (PASS) questionnaire. The PASS is on a scale from 0-10 with a higher score indicating a worse outcome. This outcome will be assessed at the consult and the 3 month follow-up appointment.
Time Frame
3 months
Title
Change in incidence of airway symptoms from consult up to 1 year assessed via electronic medical chart review
Description
Change in incidence of airway symptoms from consult up to 1 year assessed via electronic medical chart review. Notes from the Department of Otolaryngology will be reviewed which include reported symptoms from caregivers and symptoms seen upon exam. Airway symptoms included periods of apnea, chest wall retractions, cyanosis, stridor, noisy breathing, and increased respiratory rate.
Time Frame
1 year
Title
Change in incidence of dysphagia symptoms from consult up to 1 year assessed via electronic medical chart
Description
Change in incidence of dysphagia symptoms from consult up to 1 year assessed via electronic medical chart review. Notes from the Department of Otolaryngology will be reviewed which include reported symptoms from caregivers and symptoms seen upon exam. Dysphagia symptoms included choking, coughing, gagging with feeds and/or emesis after feeds.
Time Frame
1 year
Secondary Outcome Measure Information:
Title
Weight (kg) from consult up to 1 year
Description
Weight change in kilograms assessed from medical chart review from consult up to 1 year
Time Frame
1 year
Title
Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) score change from consult (baseline) to 3 month follow-up appointment
Description
Score change from pre to post survey on the I-GERQ-R. There are 12 questions on the surveys on a scale of 0-42. A higher score indicates a worse outcome. Those with a score of >=16 on this survey at the initial consult are excluded from the study, indicating true gastroesophageal reflux disease (GERD). This outcome will be assessed at the consult and the 3 month follow-up appointment.
Time Frame
3 months
Title
Number of participants with the need for supraglottoplasty surgery (escalation of treatment) up to 1 year
Description
The need for escalation of treatment with supraglottoplasty surgery will be assessed through medical chart review up to 1 year.
Time Frame
1 year
Title
Number of participants with the need for acid suppression therapy medication (famotidine) from speech language therapy alone group from the day after the consult up to the 3 month follow up appointment
Description
The speech language therapy alone group will be assessed for the need for a prescription for acid suppression therapy (famotidine) from the day after the consult up to 1 year.
Time Frame
3 months
Title
Number of participants with each type of laryngomalacia (Types 1-3) found on the Flexible Laryngoscopy procedure at the consult
Description
All patients will be scoped with a flexible laryngoscopy at the initial consult and the type of laryngomalacia (Types 1-3) will be noted.
Time Frame
At initial consult
Title
Number of participants with the need for a different acid suppression therapy medication (other than famotidine) from the day after the consult up to the 3 month follow up appointment
Description
Both groups will be assessed for the need for a different acid suppression therapy medication (other than famotidine) from the day after the consult up to the 3 month follow up appointment.
Time Frame
3 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
0 Months
Maximum Age & Unit of Time
6 Months
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Pediatric patients ages 0 to 6 months who do need meet the criteria at the initial appointment for supraglottoplasty Seen in University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh (CHP) Otolaryngology Department Laryngomalacia without prolonged (>20 seconds) cyanosis, apnea, nor failure to thrive. Exclusion Criteria: Children over the age of 6 months old will be excluded from participation. Premature infants (<37 weeks gestation) Patients with lung disease. Laryngomalacia with prolonged (>20 seconds) cyanosis, apnea, and failure to thrive Sleep induced laryngomalacia Patients with craniofacial abnormalities Patients with a syndrome Patients with additional airway abnormalities, seen before or at consult Patients with symptoms that necessitate surgery Patients with a prior cardiac surgery Patients with AST prescribed prior to the initial otolaryngology consult.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Amber D. Shaffer, PhD
Phone
412-692-6874
Email
shafferad@upmc.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Reema Padia, MD
Organizational Affiliation
Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh
Official's Role
Principal Investigator
Facility Information:
Facility Name
UPMC Children's Hospital of Pittsburgh
City
Pittsburgh
State/Province
Pennsylvania
ZIP/Postal Code
15224
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amber Shaffer, PhD
Phone
412-692-6874
Email
shafferad@upmc.edu
First Name & Middle Initial & Last Name & Degree
Marina Rushchak
Phone
412-692-9879
Email
rushchakmv4@upmc.edu

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
14623753
Citation
Rosbe KW, Kenna MA, Auerbach AD. Extraesophageal reflux in pediatric patients with upper respiratory symptoms. Arch Otolaryngol Head Neck Surg. 2003 Nov;129(11):1213-20. doi: 10.1001/archotol.129.11.1213.
Results Reference
background
PubMed Identifier
22745201
Citation
Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg. 2012 Oct;147(4):619-26. doi: 10.1177/0194599812452833. Epub 2012 Jun 27.
Results Reference
background
PubMed Identifier
11171716
Citation
Bibi H, Khvolis E, Shoseyov D, Ohaly M, Ben Dor D, London D, Ater D. The prevalence of gastroesophageal reflux in children with tracheomalacia and laryngomalacia. Chest. 2001 Feb;119(2):409-13. doi: 10.1378/chest.119.2.409.
Results Reference
background
PubMed Identifier
22518182
Citation
Landry AM, Thompson DM. Laryngomalacia: disease presentation, spectrum, and management. Int J Pediatr. 2012;2012:753526. doi: 10.1155/2012/753526. Epub 2012 Feb 27.
Results Reference
background
PubMed Identifier
20962644
Citation
Thompson DM. Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg. 2010 Dec;18(6):564-70. doi: 10.1097/MOO.0b013e3283405e48.
Results Reference
background

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Initiation of Acid Suppression Therapy Prospective Outcomes for Laryngomalacia

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