Posterior tracheopexy for preterm infants with severe bronchopulmonary dysplasia and severe tracheobronchomalacia: A case series

Abstract

We report a series of four patients with severe bronchopulmonary dysplasia (BPD) who underwent posterior tracheopexy for severe tracheomalacia (TM). While posterior tracheopexy is an established surgical treatment for TM associated with tracheoesophageal fistula, it has not been previously described in TM associated with BPD. There were no significant intraoperative or postoperative complications from the surgeries. Three of the four patients required tracheostomy and mechanical ventilation, which may reflect the degree of lung disease and other multisystem comorbidities in these patients. More investigation is needed to determine whether posterior tracheopexy is an effective surgical option for TM related to BPD.

ATS core curriculum 2023. Pediatric pulmonary medicine: Respiratory disorders in infants

“…However, in some infants, posterior tracheopexy may not alleviate this finding. 41 Premature infants also tend to experience supraglottic collapse, particularly with increased work of breathing. This is accentuated in patients with a higher and more anterior larynx, short aryepiglottic folds, and omega-shaped epiglottis-common findings in newborns, especially in those born prematurely 42 (Figure 2).…”

“…Airway phenotypes confer significant morbidity due to the need for tracheostomy, chronic ventilatory support, increased hospitalization rates, and the need for non-oral feeding. 31,41 Cristea et al provide a diagnostic algorithm for patients with postpremature respiratory disease and concern for tracheobronchomalacia. 2…”

“…Even when tracheal cartilage has a normal C‐shape, the posterior membrane can intrude into the airway lumen during increased expiratory effort (Figure 1A,B) requiring high PEEP, tracheostomy, or tracheopexy. However, in some infants, posterior tracheopexy may not alleviate this finding 41 . Premature infants also tend to experience supraglottic collapse, particularly with increased work of breathing.…”

“…Further, premature babies are at increased risk of glottic edema, granulation tissue, and acquired subglottic stenosis after intubation 40 (Figure 3). Airway phenotypes confer significant morbidity due to the need for tracheostomy, chronic ventilatory support, increased hospitalization rates, and the need for non‐oral feeding 31,41 . Cristea et al provide a diagnostic algorithm for patients with post‐premature respiratory disease and concern for tracheo‐bronchomalacia 2 …”