Airway Malacia: Clinical Features and Surgical Related Issues, a Ten-Year Experience from a Tertiary Pediatric Hospital.

Michele Ghezzi,Gloria Pelizzo,Gian Vincenzo Zuccotti,Annalisa De Silvestri,Alessandra Zenga,Valeria Calcaterra,Enza D’Auria,Andrea Farolfi

doi:10.3390/children8070613

Abstract

Background: Few studies have been carried out with the aim of describing the clinical course and follow-up of patients with tracheomalacia. We aim to describe the symptoms at diagnosis and the post-treatment clinical course of patients affected by airway malacia. Methods: We retrospectively analyzed characteristics of pediatric patients with a diagnosis of airway malacia. Patients were classified into three groups: bronchomalacia (BM), tracheomalacia (TM) and tracheo-bronchomalacia (TBM). Demographic and clinical data, diagnostic work-up and surgical treatment were recorded. Results: 13/42 patients were affected by congenital syndromes (30.9%). Esophageal atresia with or without tracheal-esophageal fistula (EA/TEF) was detected in 7/42 patients (16.7%). Cardiovascular anomalies were found in 9/42 (21.4%) and idiopathic forms in 13/42 (30.9%). BM occurred in 7/42 (16.6%), TM in 23/42 (54.7%) and TBM in 12/42 (28.6%). At the diagnosis stage, a chronic cough was reported in 50% of cases with a higher prevalence in EA/TEF (p = 0.005). Surgery was performed in 16/42 (40%) of children. A chronic cough and acute respiratory failure were correlated to the need for surgery. During follow-up, there was no difference in persistence of symptoms between conservative vs surgical treatment (p = 0.47). Conclusion: the management of tracheomalacia remains a challenge for pediatricians. Clinical manifestations, such as a barking cough and acute respiratory failure may suggest the need for surgery. Follow-up is crucial, especially in those patients affected by comorbidities, so as to be able to manage effectively the possible persistence of symptoms, including those that may continue after surgical treatment.

Highlights

During infancy, the tracheal cartilaginous framework is a crucial factor for maintaining airway patency [1]
We retrospectively reviewed the records of pediatric patients (≤18 years) who were diagnosed with airway malacia and were subsequently followed at the Pediatric Pulmonology Unit of the Children’s Hospital V
According to the level of airway malacia, TM occurred in 23/42 patients (54.7%), BM in 7/42 (16.6%) and TBM in 12/42 (28.6%), with no significant difference between sexes (p = 0.6)

Summary

Introduction

The tracheal cartilaginous framework is a crucial factor for maintaining airway patency [1]. Primary or congenital airway malacia can be subdivided into either an isolated process or it can be associated with a condition or syndrome. Congenital abnormalities such as esophageal atresia with or without tracheal-esophageal fistula (EA/TEF) are often associated with tracheomalacia [3]. We aim to describe the symptoms at diagnosis and the post-treatment clinical course of patients affected by airway malacia. Conclusion: the management of tracheomalacia remains a challenge for pediatricians Clinical manifestations, such as a barking cough and acute respiratory failure may suggest the need for surgery. Follow-up is crucial, especially in those patients affected by comorbidities, so as to be able to manage effectively the possible persistence of symptoms, including those that may continue after surgical treatment

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