Tracheobronchomalacia Is Associated with Increased Morbidity in Bronchopulmonary Dysplasia

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Rationale:Tracheobronchomalacia (TBM) is a common comorbidity in neonates with bronchopulmonary dysplasia (BPD). However, the effect of TBM on the clinical course of BPD is not well understood.Objectives:We sought to assess the impact of TBM on outcomes in neonates with BPD in a large, multicenter cohort.Methods:We performed a cohort study of 974 neonates with BPD admitted to 27 neonatal intensive care units participating in the Children's Hospital Neonatal Database who had undergone bronchoscopy. In-hospital morbidity for neonates with BPD and TBM (n = 353, 36.2%) was compared with those without TBM (n = 621, 63.8%) using mixed-effects multivariate regression.Results:Neonates with TBM and BPD had more comorbidities, such as gastroesophageal reflux (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.23-2.29; P = 0.001) and pneumonia (OR, 1.68; 95% CI, 1.21-2.33; P = 0.002), and more commonly required surgeries, such as tracheostomy (OR, 1.55; 95% CI, 1.15-2.11; P = 0.005) and gastrostomy (OR, 1.38; 95% CI: 1.03-1.85; P = 0.03), than those without TBM. Neonates with TBM were hospitalized (118 ± 93 d vs. 105 ± 83 d; P = 0.02) and ventilated (83.1 ± 91.1 d vs. 67.2 ± 71.9 d; P = 0.003) longer than those without TBM. On discharge, neonates with TBM and BPD were more likely to be mechanically ventilated (OR, 1.37; 95% CI, 1.01-1.87; P = 0.045) and possibly less likely to receive oral nutrition (OR, 0.69; 95% CI, 0.47-1.01; P = 0.058).Conclusions:TBM is common in neonates with BPD who undergo bronchoscopy and is associated with longer and more complicated hospitalizations.

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