Pediatric Tracheomalacia Follow-up

  • Author: Michael R Bye, MD; Chief Editor: Michael R Bye, MD   more...
 
Updated: Jul 22, 2011
 

Further Inpatient Care

  • Admission is not necessary unless the baby with tracheomalacia is having respiratory distress.
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Further Outpatient Care

  • No specific therapy or precautions are needed.
  • Provide outpatient care if bronchodilators are considered because they worsen the condition in some patients.
  • Follow the normal immunization schedule.
  • Reassurance during acute respiratory illnesses may be necessary. Babies may need to be seen frequently during these illnesses. During an upper respiratory infection, the normal cough sounds more crouplike in these children because the walls of the trachea appose during the cough. This also causes irritation in the tracheal walls, which prolongs the cough. The added pressures to overcome nasal obstruction adds to the dynamic collapse during the infection. As long as the baby is able to achieve adequate oral intake and is acting normally, intervention is usually not necessary.
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Inpatient & Outpatient Medications

  • No long-term medications are required.
  • Consider systemic corticosteroids during a respiratory tract infection if the baby is having difficulty breathing.
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Transfer

  • If the baby is having severe respiratory distress, transfer him or her to a pediatric intensive care unit.
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Complications

  • Severe obstruction requiring acute intervention with mechanical ventilation or positive pressure
  • Chronic obstruction necessitating surgical intervention (eg, tracheostomy, stent placement, aortopexy)
  • Aortopexy and stent placement have been compared over a 10-year followup.[7] Both are equally effective in improving symptoms and allowing for normal growth and development. Aortopexy is associated with more perioperative complications, whereas stents are associated with long-term complications and the need for removal.
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Prognosis

  • The prognosis is excellent. Most patients outgrow this condition by the time they are aged 3 years; many infants outgrow tracheomalacia before they are aged 1 year.
  • If gastroesophageal reflux is present, attention to this speeds healing.
  • Tracheomalacia after tracheoesophageal fistula repair may take longer to heal than primary tracheomalacia.
  • Tracheomalacia after a compressing lesion lasts longer, depending on the length of time of the compression.
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Patient Education

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Contributor Information and Disclosures
Author

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Susanna A McColley, MD  Professor of Pediatrics, Northwestern University, The Feinberg School of Medicine; Director of Cystic Fibrosis Center, Head, Division of Pulmonary Medicine, Children's Memorial Medical Center of Chicago

Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, and American Thoracic Society

Disclosure: Genentech Honoraria Speaking and teaching; Genentech Honoraria Consulting; Boston Scientific Consulting fee Consulting; Gilead Honoraria Speaking and teaching; Caremark Consulting fee Consulting; Vertex Pharmaceuticals Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Heidi Connolly, MD  Associate Professor of Pediatrics and Psychiatry, University of Rochester; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD  Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References

  1. Boogaard R, Huijsmans SH, Pijnenburg MW, et al. Tracheomalacia and bronchomalacia in children: incidence and patient characteristics. Chest. Nov 2005;128(5):3391-7. [Medline].

  2. Jamal N, Bent JP, Vicencio AG. A neurologic etiology for tracheomalacia?. Int J Pediatr Otorhinolaryngol. Jun 2009;73(6):885-7. [Medline].

  3. Boiselle PM, Ernst A. Tracheal morphology in patients with tracheomalacia: prevalence of inspiratory lunate and expiratory "frown" shapes. J Thorac Imaging. Aug 2006;21(3):190-6. [Medline].

  4. Vinograd I, Filler RM, Bahoric A. Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia. J Pediatr Surg. Jan 1987;22(1):38-41. [Medline].

  5. Yalcin E, Dogru D, Ozcelik U, et al. Tracheomalacia and bronchomalacia in 34 children: clinical and radiologic profiles and associations with other diseases. Clin Pediatr (Phila). Nov-Dec 2005;44(9):777-81. [Medline].

  6. Vinograd I, Keidar S, Weinberg M, Silbiger A. Treatment of airway obstruction by metallic stents in infants and children. J Thorac Cardiovasc Surg. Jul 2005;130(1):146-50. [Medline].

  7. Valerie EP, Durrant AC, Forte V, et al. A decade of using intraluminal tracheal/bronchial stents in the management of tracheomalacia and/or bronchomalacia: is it better than aortopexy?. J Pediatr Surg. Jun 2005;40(6):904-7; discussion 907. [Medline].

  8. Austin J, Ali T. Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment and anaesthesia management. Paediatr Anaesth. Jan 2003;13(1):3-11. [Medline].

  9. Casiano RR, Numa WA, Nurko YJ. Efficacy of transoral intraluminal Wallstents for tracheal stenosis or tracheomalacia. Laryngoscope. Oct 2000;110(10 Pt 1):1607-12. [Medline].

  10. Dave S, Currie BG. The role of aortopexy in severe tracheomalacia. J Pediatr Surg. Mar 2006;41(3):533-7. [Medline].

  11. [Guideline] Fayon M, Donato, L. Tracheomalacia (TM) or bronchomalacia (BM) in children: conservative or invasive therapy. (French). Archives de Pediatrie. January 2010;17:97-104.

  12. Furman RH, Backer CL, Dunham ME, et al. The use of balloon-expandable metallic stents in the treatment of pediatric tracheomalacia and bronchomalacia. Arch Otolaryngol Head Neck Surg. Feb 1999;125(2):203-7. [Medline].

  13. Inoue K, Yanagihara J, Ono S, et al. Utility of helical CT for diagnosis and operative planning in tracheomalacia after repair of esophageal atresia. Eur J Pediatr Surg. Dec 1998;8(6):355-7. [Medline].

  14. Masters IB, Chang AB. Interventions for primary (intrinsic) tracheomalacia in children. Cochrane Database Syst Rev. 2005;CD005304. [Medline].

  15. Panitch HB, Keklikian EN, Motley RA, et al. Effect of altering smooth muscle tone on maximal expiratory flows in patients with tracheomalacia. Pediatr Pulmonol. 1990;9(3):170-6. [Medline].

  16. Sirithangkul S, Ranganathan S, Robinson PJ, Robertson CF. Positive expiratory pressure to enhance cough effectiveness in tracheomalacia. Journal of the Medical Association of Thailand. November 2010;93 Suppl 6:S112-8.

 
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This shows the trachea during inspiration and expiration. Tracheal collapse of more than 50% during expiration is diagnostic of tracheomalacia.
 
 
 
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