TP078 PEDIATRIC HEALTH SERVICES RESEARCH AND QUALITY IMPROVEMENT / Thematic Poster Session An Interdisciplinary Approach to Evaluating Infants with Laryngomalacia and a Comparison with the International Consensus L Ramos 1, V Gopalakrishnan1, M SanFilippo-Burchman1, J R Sen1, A Mortelliti2, Z Soultan1; 1Department of Pediatric Pulmonary Medicine, SUNY Upstate Medical University, Syracuse, NY, United States, 2Department of Pediatric Otolaryngology, SUNY Upstate Medical University, Syracuse, NY, United States Corresponding author's email: ramosl@upstate.edu Rationale: Laryngomalacia, the most common cause of stridor in infants, is a congenital upper airway disorder of underdeveloped cartilaginous support for supraglottic structures Flexible Nasopharyngoscopy/Laryngoscopy (NPL) is the confirmatory test There is a consensus statement outlining recommendations on the diagnosis and management of laryngomalacia provided by the International Pediatric ORL Group (IPOG) (J Carter et al / International Journal of Pediatric Otorhinolaryngology 86 (2016) 256-26); however, there is no standard protocol in our institution for the care of infants presenting with laryngomalacia The purpose of this study is to review the practice of pediatric otolaryngologists and pulmonologists in our institution and compare this to the IPOG statement Methods: This is a retrospective study to review the records of patients in our institution with the ICD codes for laryngomalacia and supraglottoplasty in Epic during the years 2016-2020 We recorded age on presentation; gender; presence of symptoms; prematurity; completion of laryngoscopy, endoscopy, bronchoscopy, sleep study, and supraglottoplasty; and age at last visit and persistence of symptoms Results: There were 419 infants evaluated during this period; female n=164 Mean age of presentation was 6.33 months NPL by otolaryngologists confirmed the diagnosis in 313 patients, flexible bronchoscopy by pulmonologists in 15 patients, and rigid bronchoscopy in 51 patients Ten patients underwent both flexible and rigid bronchoscopy Some patients had flexible bronchoscopies done although there was no indication of a secondary airway lesion The majority of the patients (n=367) underwent watchful watching if there were no indication of secondary airway concern or feeding issues Of these, 219 children were noted to have resolution or improvement of symptoms Ten children are still being followed for continued evaluation of laryngomalacia Conclusions: The approach to the management of infants presenting with laryngomalacia differs between pediatric pulmonologists and otolaryngologists at our institution Pediatric pulmonologists typically diagnosed laryngomalacia either with clinical observation only or with flexible bronchoscopy under anesthesia Some patients evaluated by a pediatric pulmonologist were not also evaluated by a pediatric otolaryngologist Pediatric otolaryngologists at our institution generally seemed to be following the IPOG statement and performed an NPL on all infants with laryngomalacia Of the infants who did not undergo intervention, the majority self-resolved Thus, supraglottoplasty is rarely needed After careful review of the IPOG statement and our own institutional practice, we plan to streamline care for the benefit and safety of our patients This abstract is funded by: None Am J Respir Crit Care Med 2021;203:A3469 Internet address: www.atsjournals.org Online Abstracts Issue