Clinical Outcomes Through Two Years for Infants With Bronchopulmonary Dysplasia and Tracheomalacia.

Autor: Zak SM; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA., Onge IS; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA., Higano NS; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Department of Radiology, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA., Bates AJ; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Department of Radiology, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Complex Obstructive Sleep Apnea Center, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA., Gandhi D; Department of Radiology, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA., Fleck RJ; Department of Radiology, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Complex Obstructive Sleep Apnea Center, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA., Kingma PS; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA., Woods JC; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Department of Radiology, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Radiology and Physics, University of Cincinnati, Cincinnati, Ohio, USA., Hysinger EB; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.; Department of Radiology, Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
Jazyk: angličtina
Zdroj: Pediatric pulmonology [Pediatr Pulmonol] 2024 Dec 05. Date of Electronic Publication: 2024 Dec 05.
DOI: 10.1002/ppul.27383
Abstrakt: Background: Tracheomalacia (TM) is common in infants with bronchopulmonary dysplasia (BPD) and associated with respiratory morbidity. Assessment of TM was historically via bronchoscopy, but recent studies demonstrate that ultrashort echo-time (UTE) magnetic resonance imaging (MRI) can accurately assess TM in neonates.
Research Question: Do neonates with MRI-identified TM and BPD have increased respiratory morbidity through age 2 years?
Methods: We performed an observational cohort study of 54 subjects with BPD and assessed TM using UTE MRI at term-equivalent age. TM was defined as an airway minor/major axis ratio (r d,min ) of < 0.7. Outcomes through 2 years of life were evaluated via electronic medical record review.
Results: There were 23 subjects (43%) with TM. Modified Ochiai MRI scores were similar between the subjects with and without TM (7.3 ± 4.1 vs. 7.4 ± 4.1). Subjects with TM were more likely to require respiratory support at age 2 years (62% vs. 30%, p = 0.04) and be prescribed systemic corticosteroids (71% vs. 27%, p = 0.004). Most patients with TM were prescribed bronchodilators (90% vs. 60%, p = 0.04). A 10% increase in tracheal collapse correlated with a 28-day increased hospital length of stay (p = 0.047), increased likelihood of pneumonia (p = 0.05), and treatment with antibiotics (p = 0.04) and systemic steroids (p = 0.008).
Conclusions: TM in the neonatal period was associated with increased respiratory morbidity through age 2 years, demonstrated by increased respiratory support and more frequent usage of systemic corticosteroids and bronchodilators, independent of the severity of BPD. These results highlight the significance of central airway disease in neonates with BPD.
(© 2024 The Author(s). Pediatric Pulmonology published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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