Cluster analysis of laryngomalacia in infants: insights into prognostic factors from a 10-year cohort

Purpose: Laryngomalacia exhibits diverse morphological patterns, severities, and comorbidities.Defining clinical phenotypes could improve management and prognosis.This study aimed to identify and characterize phenotypes using cluster analysis and to evaluate prognostic factors.Methods: We retrospectively reviewed records of 195 children diagnosed with laryngomalacia between 2014 and 2023 using flexible laryngoscopy or bronchoscopy.Demographics, endoscopic findings, comorbidities, and outcomes up to 1 year of age were collected.Hierarchical cluster analysis was conducted using 10 clinical variables.Results: Four phenotypes emerged: cluster 1 (n= 75, 38.5%), Groningen Laryngomalacia Classification System (GLCS) type 1 dominant-mild; cluster 2 (n = 35, 17.9%), GLCS type 2 dominant-mild; cluster 3 (n = 40, 20.5%), severe with multiple comorbidities; and cluster 4 (n= 45, 23.1%), GLCS combined-type moderate.Distinct clinical courses were observed.Cluster 3 showed the highest rates of surgical intervention (32.5%, P < 0.001), pediatric intensive care unit admission (17.5%, P = 0.016), and Emergency Department (ED) visits (60.0%,P= 0.013) for respiratory problems during the first year.When stratified by comorbidities, children with multiple comorbidities, particularly those with major feeding problems had a higher risk of hospitalization (adjusted odds ratio aOR, 2.65; 95% confidence interval CI, 1.11-6.33)and ED visits (aOR, 3.17; 95% CI, 1.39-7.23),even after adjusting for sex and severity.Conclusion: Four clinically meaningful phenotypes of laryngomalacia were identified from the cluster analysis based on morphology, comorbidities, and disease severity.Children with multiple comorbidities accompanied by feeding problems had the greatest risk of hospitalization and ED visits for respiratory problems within the first year, even after adjusting for the severity of laryngomalacia.(