Respiratory findings and growth parameters in pediatric patients with airway Malacia

Tracheomalacia (TM), bronchomalacia (BM), and tracheobronchomalacia (TBM) are important causes of dynamic airway collapse in children and are associated with recurrent respiratory symptoms and increased morbidity. The primary aims of this study were to describe anthropometric parameters in pediatric patients with airway malacia diagnosed by flexible fiberoptic bronchoscopy (FFB) and to determine the prevalence of undernutrition at diagnosis. The secondary aim was to examine nutritional status by age group and malacia subtype. This retrospective study included pediatric patients diagnosed with airway malacia by flexible fiberoptic bronchoscopy (FFB) between January 2019 and February 2025. Anthropometric measurements obtained at diagnosis were evaluated using World Health Organization growth standards for children < 2 years and the U.S. Centers for Disease Control and Prevention 2000 growth charts for those ≥ 2 years. Acute malnutrition was defined as weight-for-length or BMI-for-age z-scores <  - 2, and chronic malnutrition as height-for-age z-scores <  - 2. Nutritional status severity was classified according to standard z-score cutoffs. Exploratory analyses compared anthropometric measurements across malacia subtypes within each age group. Among 1,248 pediatric patients who underwent FFB, 129 (10.3%) diagnosed airway malacia: 32 (24.8%) had TM, 51 (39.5%) had BM, and 46 (35.7%) had TBM. Among these patients, the median age was 1.2 years (interquartile range: 0.5-3.2), and 79 (61.2%) were male. Additionally, 31 (24.8%) had acute malnutrition, and 30 (23.3%) had chronic malnutrition. Among patients aged < 2 years, the weight-for-age percentile and z-score were significantly lower among those with TBM than among those with BM (p = 0.040 and p = 0.047, respectively). Among patients aged ≥ 2 years, the height-for-age percentile and z-score were significantly lower among those with TM and TBM than among those with BM (both p = 0.002; TM vs. BM: p = 0.009; TBM vs. BM: p = 0.008). Body mass index and related parameters did not differ significantly between malacia subtypes.Conclusions: Growth impairment is common in pediatric patients with airway malacia, particularly among those with TBM. Anthropometric evaluation should be an integral part of clinical assessment at the time of diagnosis to identify those at risk of growth failure.