Bronchoscopic assessments and clinical outcomes in pediatric patients with tracheomalacia and bronchomalacia

Pediatr Surg Int. 2018 Jan;34(1):55-61. doi: 10.1007/s00383-017-4209-x. Epub 2017 Nov 9.


Background: Tracheomalacia and bronchomalacia (TM/BM) are one of the serious causes of airway obstruction in infants and children. This study reviewed our bronchoscopic assessments and clinical outcomes in pediatric patients with TM/BM, and investigated risk factors of surgical intervention for TM/BM.

Methods: Fifty-seven consecutive patients who were diagnosed as TM/BM by bronchoscopy between 2009 and 2013 were reviewed retrospectively. They were divided into two groups according to the presence (group E, n = 26) or absence (group N, n = 31) of acute life-threatening events and extubation failure (ALTE/EF). The severity of TM/BM was evaluated by Oblateness Index which was obtained from bronchoscopic images.

Results: Oblateness Index was significantly higher in Group E than in Group N. Patients in Group E underwent surgical intervention for TM/BM more frequently, and had significantly longer intubation period and hospital stay. Clinical symptoms of ALTE/EF, Oblateness Index ≥ 0.70, and multiple malacic lesions were significant risk factors indicating surgical events in patients with TM/BM.

Conclusions: Patients with TM/BM who had ALTE/EF had more severe malacic lesions indicating surgical intervention, and worse clinical outcomes. Oblateness Index is a simple and semi-quantitative index for bronchoscopic assessment of TM/BM, and can be one of the prognostic tools to predict clinical severity of pediatric TM/BM.

Keywords: Acute life-threatening event; Bronchomalacia; Surgical intervention; Tracheomalacia.

MeSH terms

  • Bronchomalacia / diagnosis
  • Bronchomalacia / surgery*
  • Bronchoscopy*
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Length of Stay
  • Male
  • Patient Outcome Assessment*
  • Retrospective Studies
  • Severity of Illness Index*
  • Tracheomalacia / diagnosis
  • Tracheomalacia / surgery*