270 - Dynamic Computed Tomography for Evaluation of Tracheobronchomalacia in Premature Infants with Bronchopulmonary Dysplasia

Poster Number: 270
Publication Number: 270.341

Charles P. Pugh, Arkansas Children's Hospital, Little Rock, AR, United States; Sumera Ali, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Amit Agarwal, ach, Little Rock, AR, United States; David Matlock, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Megha Sharma, University of Arkansas for Medical Sciences, Little Rock, AR, United States

Background: Tracheobronchomalacia (TBM) refers to excessive collapsibility of central airways during expiration. Infants with TBM experience higher respiratory morbidity, suggesting need for timely, accurate diagnosis and targeted interventions. Bronchoscopy has historically been the standard for diagnosing TBM; however, it may be limited due to the invasive nature, interobserver variability, and imprecision of subjective/semi-quantitative data. Thus, there is need for a non-invasive, objective diagnostic approach for evaluating airway abnormalities in infants. A newer technique, dynamic computed tomography (dCT), gives real-time physiological information and objective descriptions of airway narrowing. Studies have shown that dCT is effective in the evaluation of TBM with good correlation with bronchoscopy, but there is a paucity of literature about its application to evaluate TBM in infants with BPD.

Objective: To describe the indications, findings, and resulting changes in clinical management of TBM in infants with BPD diagnosed by dCT.

Design/Methods: This is a retrospective review of 70 infants from 2017 – 2022 who underwent dCT at a level IV neonatal intensive care unit. Inclusion criteria was infants less than 32 weeks of gestation without major genetic, congenital airway or cardiac anomalies. TBM was defined as > 50% expiratory reduction in cross-sectional luminal area with severity defined as mild (50–75% reduction), moderate ( >75–90% reduction), or severe ( >90% reduction). Descriptive statistics were performed to analyze the cohort and depict how often there was a change in clinical management based on dCT.

Results: Dynamic CT diagnosed airway malacia in 37/70 (53%) infants with > 50% expiratory collapse on imaging (Figure 1). Tracheomalacia was identified in 34/70 (49%) infants with severity of 76% mild, 18% moderate, and 6% severe (Table 1). Bronchomalacia was identified in 30/70 (43%) infants with severity of 53% mild, 40% moderate, and 7% severe. Combined tracheobrochomalacia was noted in 27/70 (39%) infants. Findings from dCT resulted in change in clinical management in 64/70 (91%) infants (Table 2). The most common interventions included PEEP titration (44%), initiation of bethanechol (23%), planned tracheostomy (20%), extubation trial (13%), and inhaled ipratropium bromide (7%).

Conclusion(s): Dynamic CT has potential as a non-invasive diagnostic tool for the airway evaluation of premature infants requiring protracted and prolonged positive pressure ventilation. Objective evidence of the presence and severity of TBM can provide actionable information to guide more precise clinical decision making.