Clinical survey and predictors for the development of tracheobronchomalacia in preterm infants

Background: Tracheobronchomalacia (TBM) contributes to the increased morbidity and mortality observed in preterm infants. Effective strategies for the prevention of TBM are necessary to achieve better outcomes. We sought to identify risk factors associated with the development of TBM in preterm infants. Optimal cut-off values for each risk factor were also determined. Methods: A total of 80 infants who were born at 36 week's gestation or earlier and underwent flexible bronchoscopy were included in our study sample. A comparison of demographic and clinical risk factors between those with TBM (n = 35, 44%) and those without TBM (n = 45, 56%) was conducted using multivariate logistic regression analysis. Receiver operating characteristic curve analysis was performed to determine the appropriate cut-off values for predicting the development of TBM. Results: In the multivariate analysis, only peak inspiratory pressure (PIP) and the number of intubation days remained significantly different between infants with and without TBM. Preterm infants with TBM received higher PIP (odds ratio: [OR], 1.067; 95% confidence interval [CI], 1.010–1.128; p =.020) and were intubated for longer (odds ratio [OR], 1.019; 95% CI, 1.003–1.035; p =.016) than those without TBM. Infants who received PIP > 19.5 cmH₂O or were intubated for >79.5 days were associated with a significantly higher risk of presence of TBM. Conclusion: High PIP and prolonged intubation were major risk factors for the development of TBM in premature infants. Those who require PIP > 19.5 cmH₂O or intubation >79.5 days warrant bronchoscopy examination for early diagnosis and management of TBM.