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Pediatric Tracheomalacia Follow-up

  • Author: Emily Concepcion, DO; Chief Editor: Michael R Bye, MD  more...
 
Updated: Oct 25, 2015
 

Further Outpatient Care

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  • 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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Further Inpatient Care

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  • Admission is not necessary unless the baby with tracheomalacia is having respiratory distress.
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Inpatient & Outpatient Medications

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  • 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

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

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  • 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

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  • 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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  • For excellent patient education resources, see eMedicineHealth's patient education article Bronchoscopy.
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Contributor Information and Disclosures
Author

Emily Concepcion, DO Fellow, Department of Pediatric Pulmonology, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

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

Disclosure: Nothing to disclose.

Additional Contributors

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, American Thoracic Society

Disclosure: Received honoraria from Genentech for speaking and teaching; Received honoraria from Genentech for consulting; Partner received consulting fee from Boston Scientific for consulting; Received honoraria from Gilead for speaking and teaching; Received consulting fee from Caremark for consulting; Received honoraria from Vertex Pharmaceuticals for speaking and teaching.

Acknowledgements

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; 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.

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

  2. Jamal N, Bent JP, Vicencio AG. A neurologic etiology for tracheomalacia?. Int J Pediatr Otorhinolaryngol. 2009 Jun. 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. 2006 Aug. 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. 1987 Jan. 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). 2005 Nov-Dec. 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. 2005 Jul. 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. 2005 Jun. 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. 2003 Jan. 13(1):3-11. [Medline].

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

  10. Dave S, Currie BG. The role of aortopexy in severe tracheomalacia. J Pediatr Surg. 2006 Mar. 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. 1999 Feb. 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. 1998 Dec. 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.

  17. van der Zee DC, Straver M. Thoracoscopic aortopexy for tracheomalacia. World J Surg. 2015 Jan. 39 (1):158-64. [Medline].

  18. Montgomery J, Sau C, Clement W, Danton M, Davis C, Haddock G, et al. Treatment of tracheomalacia with aortopexy in children in Glasgow. Eur J Pediatr Surg. 2014 Oct. 24 (5):389-93. [Medline].

  19. Arnaud AP, Rex D, Elliott MJ, Curry J, Kiely E, Pierro A, et al. Early experience of thoracoscopic aortopexy for severe tracheomalacia in infants after esophageal atresia and tracheo-esophageal fistula repair. J Laparoendosc Adv Surg Tech A. 2014 Jul. 24 (7):508-12. [Medline].

  20. Jennings RW, Hamilton TE, Smithers CJ, Ngerncham M, Feins N, Foker JE. Surgical approaches to aortopexy for severe tracheomalacia. J Pediatr Surg. 2014 Jan. 49 (1):66-70; discussion 70-1. [Medline].

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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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