Clinical Features Of Airway Malacia In Children: A Retrospective Analysis Of459Patients

ObjectiveTo investigate the clinical features of airway malacia in children.MethodsTotally,459children primarily diagnosed with airway malacia usingfiexible bronchofiberscope in Children’s Hospital of Chongqing MedicalUniversity from January2009to December2012were included in thisretrospective study.Results1. In our study,369children (male:311, female:58) were aged less than12months,76children (male:57, female:19) were aged1~2years,9children (male:6, female:3) were aged2~3years, and5children (male:2,female:3) aged more than3years old.2.The number of children with tracheomalacia, tracheobronchomalacia,and bronchomalacia was7(1.5%),17(3.7%), and435(94.8%), respectively.The incidence of bronchomalacia on left lung was11.0%(n=48), while thatof right lung was53.3%(n=232). Meanwhile, bronchomalacia of both lungs were noticed in155children (35.6%). With regards to the extent of malacia,the number of children with slight, moderate and severe malacia was226,195, and38, respectively. For the scale of disease, focal malacia was noticedin246children (53.6%), while multiple malacia was noticed in213children(46.4%). Besides malacia, the combined lesions included laryngomalacia(n=14), tracheostenosis or bronchial stenosis (n=271), variation ofbronchial opening (n=52), abnormal passages of trachea (n=3), purulentendotracheitis (n=3), granulation tissue formation (n=2), and nodule-likelesions in the posterior wall of the trachea (n=1).3. All the children enrolled in this study were diagnosed withpulmonary infection, among which376were diagnosed with ordinarypneumonia,83were diagnosed with severe pneumonia.227childrenshowed a disease course of less than1month, while201children reported adisease course of1~3months, and at the same time,31children reported adisease course of more than3months.4. Statistical difference was noticed in the disease condition ofrespiratory tract infection of patients with various malacia extent (P＜0.05).No statistical difference was noticed in the disease course of respiratory tractinfection of patients with various malacia extent (P>0.05). No statisticaldifference was noticed in the disease course or disease condition ofrespiratory tract infection of patients with various malacia scale (P>0.05).5. Besides respiratory tract infection, other complications included atelectasis (n=32), bronchial asthma (n=28), gastroesophageal reflux (n=12),atrial septal defect (n=20), ventricular septal defect (n=1), patent ductusarteriosus (n=5), pulmonary hypertension (n=3), aberrant right subclavianatery (n=1), trachea depression induced by left superior pulmonary vein(n=1), pulmonary hernia (n=1), cystic disease of lung (n=1), thoracic orspinal deformity (n=3), eventration of diaphragm (n=1), zenetralekoonlination storung (n=5), cerebral palsy (n=3), epilepsy (n=2),hydrocephalus (n=2), congenital chilopalatognathus (n=4), trachealbronchus (n=2), and Pierre Robin syndrome (n=1).6. Re-check of fiexible bronchofiberscope was performed in19patients,among which14patients (73.7%) showed improvement compared with theprevious conditions. No significant improvement was noticed in4patients,while1patient showed deterioration in malacia extent.Conclusions1. Airway malacia has been frequently noticed in male children aged≤2years old. The incidence of bronchomalacia was comparatively higherthan that of the tracheobronchomalacia or tracheomalacia. The incidence ofbronchomalacia in right lung was higher than that of left lung. Malacia inbronchus lobaris superior dexter was the most frequently observed type.Most of the patients were suffered from mild and moderate malaciacompared with severe malacia.2. Patients with severe airway malacia were apt to develop severe pneumonia compared with those with slight or moderate malacia.3. No correlation was identified between the disease course ofrespiratory tract infection and extent/scale of the malacia. Additionally, nocorrelation was observed between the extent of pneumonia and the scale ofthe malacia.4. Airway malacia may also combined with other congenital disorders.5. Improvements or even elimination of malacia were noticed with theaging of the children and the anti-infection therapy.6. For the diagnosis of primary airway malacia, single fiexiblebronchofiberscope is not effective, and further determination is necessary.