Risk Factors for Tracheobronchomalacia in Preterm Infants With Bronchopulmonary Dysplasia

Ya-Ting Su, Chun-Che Chiu, Shen-Hao Lai, Shao-Hsuan Hsia, Jainn-Jim Lin, Oi-Wa Chan, Chih-Yung Chiu, Pei-Ling Tseng, En-Pei Lee, Ya-Ting Su, Chun-Che Chiu, Shen-Hao Lai, Shao-Hsuan Hsia, Jainn-Jim Lin, Oi-Wa Chan, Chih-Yung Chiu, Pei-Ling Tseng, En-Pei Lee

Abstract

Aim: To identify the risk factors associated with the development of tracheobronchomalacia (TBM) in preterm infants with bronchopulmonary dysplasia (BPD). Methods: This was a retrospective cohort study using chart reviews of preterm infants born at ≤ 36 week's gestation who underwent flexible fiberoptic bronchoscopy in a tertiary pediatric referral center between January 2015 and January 2020. Indications for the bronchoscopy examination included lobar atelectasis on plain chest film, persistent CO2 retention, recurrent extubation failure, or abnormal breathing sounds such as wheeze or stridor. Optimal cutoff values for each risk factor were also determined. Results: Fifty-eight preterm infants with BPD were enrolled, of whom 29 (50%) had TBM. There were no significant differences in gestational age and birth weight between those with and without TBM. Significantly more of the patients with TBM had severe BPD compared to those without TBM (68.9 vs. 20.6%, p < 0.001). Clinical parameters that were significantly different between the two groups were included in multivariate analysis. Among these factors, severe BPD was the most powerful risk factor for the development of TBM (odds ratio 5.57, 95% confidence interval 1.32-23.5, p = 0.019). The areas under the receiver operating characteristic curves for peak inspiratory pressure (PIP) and the duration of intubation were 0.788 and 0.75, respectively. The best predictive cutoff values of PIP and duration of intubation for TBM were 18.5 mmHg and 82 days, respectively. Conclusion: Preterm infants with severe BPD are at high risk for the development of TBM, and the risk is even higher in those who receive a higher PIP or are intubated for longer. Bronchoscopy examinations should be considered for the early diagnosis and management of TBM in infants with these risk factors.

Keywords: bronchopulmonary dysplasia; bronchoscopy; preterm infants; risk factors; tracheobronchomalacia.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Su, Chiu, Lai, Hsia, Lin, Chan, Chiu, Tseng and Lee.

Figures

Figure 1
Figure 1
Flow diagram of study inclusion of preterm infants with BPD who underwent flexible bronchoscopy.
Figure 2
Figure 2
Receiver operating characteristic curves to assess the predictive accuracy of parameters for TBM. (A) Peak inspiratory pressure. (B) Duration of intubation (days).

References

    1. Hysinger EB, Panitch HB. Paediatric Tracheomalacia. Paediatr Respir Rev. (2016) 17:9–15. 10.1016/j.prrv.2015.03.002
    1. Boogaard R, Huijsmans SH, Pijnenburg MW, Tiddens HA, de Jongste JC, Merkus PJ. Tracheomalacia and bronchomalacia in children: incidence and patient characteristics. Chest. (2005) 128:3391–7. 10.1378/chest.128.5.3391
    1. Sotomayor JL, Godinez RI, Borden S, Wilmott RW. Large-airway collapse due to acquired tracheobronchomalacia in infancy. Am J Dis Child. (1986) 140:367–71. 10.1001/archpedi.1986.02140180101035
    1. Greenholz SK, Hall RJ, Lilly JR, Shikes RH. Surgical implications of bronchopulmonary dysplasia. J Pediatr Surg. (1987) 22:1132–36. 10.1016/S0022-3468(87)80723-6
    1. Downing GJ, Kilbride HW. Evaluation of airway complications in high-risk preterm infants: application of flexible fiberoptic airway endoscopy. Pediatrics. (1995) 95:567–72.
    1. Penn RB, Wolfson MR, Shaffer TH. Effect of ventilation on mechanical properties and pressure-flow relationships of immature airways. Pediatr Res. (1988) 23:519–24. 10.1203/00006450-198805000-00017
    1. Miller RW, Woo P, Kellman RK, Slagle TS. Tracheobronchial abnormalities in infants with bronchopulmonary dysplasia. J Pediatr. (1987) 111:779–82. 10.1016/S0022-3476(87)80267-6
    1. McCubbin M, Frey EE, Wagener JS, Tribby R, Smith WL. Large airway collapse in bronchopulmonary dysplasia. J Pediatr. (1989) 114:304–7. 10.1016/S0022-3476(89)80802-9
    1. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. (2001) 163:1723–9. 10.1164/ajrccm.163.7.2011060
    1. Tan JZ, Ditchfield M, Freezer N. Tracheobronchomalacia in children: review of diagnosis and definition. Pediatr Radiol. (2012) 42:906–15; quiz 1027–1028. 10.1007/s00247-012-2367-5
    1. Murgu SD, Colt HG. Tracheobronchomalacia and excessive dynamic airway collapse. Respirology. (2006) 11:388–406. 10.1111/j.1440-1843.2006.00862.x
    1. Hysinger EB, Friedman NL, Padula MA, Shinohara RT, Zhang H, Panitch HB, et al. . Tracheobronchomalacia is associated with increased morbidity in bronchopulmonary dysplasia. Ann Am Thorac Soc. (2017) 14:1428–35. 10.1513/AnnalsATS.201702-178OC
    1. Deoras KS, Wolfson MR, Searls RL, Hilfer SR, Shaffer TH. Developmental changes in tracheal structure. Pediatric Res. (1991) 30:170–5. 10.1203/00006450-199108000-00010
    1. Austin J, Ali T. Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment and anaesthesia management. Paediatr Anaesth. (2003) 13:3–11. 10.1046/j.1460-9592.2003.00802.x
    1. Napolitano N, Jalal K, McDonough JM, Monk HM, Zhang H, Jensen E, et al. . Identifying and treating intrinsic PEEP in infants with severe bronchopulmonary dysplasia. Pediatr Pulmonol. (2019) 54:1045–51. 10.1002/ppul.24328
    1. Bhutani VK, Rubenstein D, Shaffer TH. Pressure-induced deformation in immature airways. Pediatric Res. (1981) 15:829–32.
    1. Choi S, Lawlor C, Rahbar R, Jennings R. Diagnosis, classification, and management of pediatric tracheobronchomalacia: a review. JAMA Otolaryngol Head Neck Surg. (2019) 145:265–75. 10.1001/jamaoto.2018.3276
    1. Bhutani VK, Rubenstein SD, Shaffer TH. Pressure–volume relationships of tracheae in fetal newborn and adult rabbits. Respiration Physiol. (1981) 43:221–31. 10.1016/0034-5687(81)90104-3
    1. Feist JH, Johnson TH, Wilson RJ. Acquired tracheomalacia: etiology and differential diagnosis. Chest. (1975) 68:340–5. 10.1378/chest.68.3.340
    1. Ridge CA, O'Donnell CR, Lee EY, Majid A, Boiselle PM. Tracheobronchomalacia: current concepts and controversies. J Thorac Imaging. (2011) 26:278–89. 10.1097/RTI.0b013e3182203342
    1. Mok Q. Airway problems in neonates-a review of the current investigation and management strategies. Front Pediatr. (2017) 5:60. 10.3389/fped.2017.00060
    1. Zhang H, Zhang J, Zhao S. Airway damage of prematurity: the impact of prolonged intubation, ventilation, and chronic lung disease. Semin Fetal Neonatal Med. (2016) 21:246–53. 10.1016/j.siny.2016.04.001
    1. McNamara VM, Crabbe DC. Tracheomalacia. Paediatr Respir Rev. (2004) 5:147–54. 10.1016/j.prrv.2004.01.010
    1. Yang D, Cascella M. Tracheomalacia. In: StatPearls. Treasure Island, FL: StatPearls Publishing LLC; (2020).
    1. Wallis C, Priftis K, Chang A, Midulla F, Bhatt J. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J. (2019) 54:1902271. 10.1183/13993003.02271-2019
    1. Okata Y, Hasegawa T, Bitoh Y, Maeda K. Bronchoscopic assessments and clinical outcomes in pediatric patients with tracheomalacia and bronchomalacia. Pediatr Surg Int. (2018) 34:55–61. 10.1007/s00383-017-4209-x
    1. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: predictors and management. Indian J Crit Care Med. (2008) 12:1–9. 10.4103/0972-5229.40942

Source: PubMed

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