Tracheobronchomalacia Is Associated with Increased Morbidity in Bronchopulmonary Dysplasia

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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.


We sought to assess the impact of TBM on outcomes in neonates with BPD in a large, multicenter cohort.


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.


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).


TBM is common in neonates with BPD who undergo bronchoscopy and is associated with longer and more complicated hospitalizations.

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