Related Experiment Video
Updated: Jun 5, 2025
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Clinical Outcomes Through Two Years for Infants With Bronchopulmonary Dysplasia and Tracheomalacia
Sara M Zak1,2, Ina St Onge1, Nara S Higano1,2,3
1Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
Insights
Neonatal tracheomalacia (TM) in infants with bronchopulmonary dysplasia (BPD) is linked to greater respiratory issues up to age two. Ultrashort echo-time MRI accurately identifies TM, highlighting the need for central airway assessment in BPD patients.
Area of Science:
- Pediatric Pulmonology
- Neonatal Imaging
- Respiratory Medicine
Background:
- Tracheomalacia (TM) is prevalent in infants with bronchopulmonary dysplasia (BPD), contributing to significant respiratory morbidity.
- Traditional assessment of TM via bronchoscopy is invasive; ultrashort echo-time (UTE) MRI offers a non-invasive alternative for neonates.
Purpose of the Study:
- To determine if neonates with MRI-identified TM and BPD experience increased respiratory morbidity up to age 2 years.
- To evaluate the long-term respiratory outcomes associated with neonatal TM in the context of BPD.
Main Methods:
- An observational cohort study involved 54 infants with BPD, assessing TM using UTE MRI at term-equivalent age.
- TM was defined by an airway minor/major axis ratio (rd,min) < 0.7.
- Respiratory outcomes were tracked through age 2 years via electronic medical record review.
Main Results:
- 43% of subjects (23/54) had TM. Infants with TM were more likely to require respiratory support (62% vs. 30%) and systemic corticosteroids (71% vs. 27%) at age 2.
- TM was associated with increased bronchodilator use (90% vs. 60%).
- A 10% increase in tracheal collapse correlated with longer hospital stays, increased pneumonia risk, and greater use of antibiotics and systemic steroids.
Conclusions:
- Neonatal tracheomalacia is associated with increased respiratory morbidity through age 2 years in infants with BPD.
- This includes higher rates of respiratory support, systemic corticosteroids, and bronchodilator use, irrespective of BPD severity.
- The findings underscore the importance of evaluating central airway disease in neonates diagnosed with BPD.
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 (rd,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.
Related Concept Videos
01:17Pulmonary Cycle: Exhalation
01:27Pneumothorax-II
Clinical Manifestations:
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...