Zak Sara M, Onge Ina St, Higano Nara S, Bates Alister J, Gandhi Deep, Fleck Robert J, Kingma Paul S, Woods Jason C, Hysinger Erik B
Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Pediatr Pulmonol. 2025 Jan;60(1):e27383. doi: 10.1002/ppul.27383. Epub 2024 Dec 5.
Tracheomalacia (TM) is common in infants with bronchopulmonary dysplasia (BPD) and associated with respiratory morbidity. Assessment of TM was historically via bronchoscopy, but recent studies demonstrate that ultrashort echo-time (UTE) magnetic resonance imaging (MRI) can accurately assess TM in neonates.
Do neonates with MRI-identified TM and BPD have increased respiratory morbidity through age 2 years?
We performed an observational cohort study of 54 subjects with BPD and assessed TM using UTE MRI at term-equivalent age. TM was defined as an airway minor/major axis ratio (r) of < 0.7. Outcomes through 2 years of life were evaluated via electronic medical record review.
There were 23 subjects (43%) with TM. Modified Ochiai MRI scores were similar between the subjects with and without TM (7.3 ± 4.1 vs. 7.4 ± 4.1). Subjects with TM were more likely to require respiratory support at age 2 years (62% vs. 30%, p = 0.04) and be prescribed systemic corticosteroids (71% vs. 27%, p = 0.004). Most patients with TM were prescribed bronchodilators (90% vs. 60%, p = 0.04). A 10% increase in tracheal collapse correlated with a 28-day increased hospital length of stay (p = 0.047), increased likelihood of pneumonia (p = 0.05), and treatment with antibiotics (p = 0.04) and systemic steroids (p = 0.008).
TM in the neonatal period was associated with increased respiratory morbidity through age 2 years, demonstrated by increased respiratory support and more frequent usage of systemic corticosteroids and bronchodilators, independent of the severity of BPD. These results highlight the significance of central airway disease in neonates with BPD.
气管软化（TM）在支气管肺发育不良（BPD）婴儿中很常见，且与呼吸系统疾病相关。历史上，TM的评估是通过支气管镜检查进行的，但最近的研究表明，超短回波时间（UTE）磁共振成像（MRI）能够准确评估新生儿的TM。
MRI确诊为TM且患有BPD的新生儿在2岁前呼吸系统疾病发病率是否增加？
我们对54例BPD患者进行了一项观察性队列研究，并在足月等效年龄时使用UTE MRI评估TM。TM定义为气道短轴/长轴比（r）<0.7。通过电子病历回顾评估2岁前的结局。
有23例患者（43%）患有TM。有TM和无TM的患者改良大池蛛网膜下腔MRI评分相似（7.3±4.1 vs. 7.4±4.1）。患有TM的患者在2岁时更有可能需要呼吸支持（62% vs. 30%，p = 0.04），并被开具全身性皮质类固醇药物（71% vs. 27%，p = 0.004）。大多数患有TM的患者被开具支气管扩张剂（90% vs. 60%，p = 0.04）。气管塌陷增加10%与住院时间延长28天相关（p = 0.047），肺炎发生可能性增加（p = 0.05），以及使用抗生素（p = 0.04）和全身性类固醇药物治疗（p = 0.008）。
新生儿期的TM与2岁前呼吸系统疾病发病率增加相关，表现为呼吸支持需求增加以及全身性皮质类固醇药物和支气管扩张剂使用更频繁，且与BPD的严重程度无关。这些结果凸显了中央气道疾病在患有BPD的新生儿中的重要性。
