Dynamic computed tomography for evaluation of tracheobronchomalacia in premature infants with bronchopulmonary dysplasia

Author:

Pugh Charles Preston1ORCID,Ali Sumera2,Agarwal Amit1ORCID,Matlock David N.1,Sharma Megha1ORCID

Affiliation:

1. Department of Pediatrics University of Arkansas for Medical Sciences Little Rock Arkansas USA

2. Department of Radiology Children's Hospital of Atlanta Emory University Atlanta Georgia USA

Abstract

AbstractIntroductionDynamic computed tomography (dCT) gives real‐time physiological information and objective descriptions of airway narrowing in tracheobronchomalacia (TBM). There is a paucity of literature in the evaluation of TBM by dCT in premature infants with bronchopulmonary dysplasia (BPD). The aim of this study is to describe the findings of dCT and resultant changes in management in premature infants with TBM.MethodsA retrospective study of 70 infants was performed. Infants included were <32 weeks gestation without major anomalies. TBM was defined as ≥50% expiratory reduction in cross‐sectional area with severity defined as mild (50%–75%), moderate (≥75%–90%), or severe (≥90%).ResultsDynamic CT diagnosed malacia in 53% of infants. Tracheomalacia was identified in 49% of infants with severity as 76% mild, 18% moderate, and 6% severe. Bronchomalacia was identified in 43% of infants with varying severity (53% mild, 40% moderate, 7% severe). Resultant management changes included PEEP titration (44%), initiation of bethanechol (23%), planned tracheostomy (20%), extubation trial (13%), and inhaled ipratropium bromide (7%).ConclusionDynamic CT is a useful noninvasive diagnostic tool for airway evaluation of premature infants. Presence and severity of TBM can provide actionable information to guide more precise clinical decision making.

Publisher

Wiley

Subject

Pulmonary and Respiratory Medicine,Pediatrics, Perinatology and Child Health

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