OPP3 PREVALENCE, CLINICAL CHARACTERISTICS AND OUTCOMES OF CHILDREN WITH AIRWAY MALACIA AT UNIVERSITY OF MALAYA MEDICAL CENTRE

Wan Nur Iffah Ahmad Anuar1, Kah Peng Eg1, Shih Ying H’ng2, Siti Hajar Tubirin2, Jessie Anne de Bruyne2, Anna Marie Nathan1
1University of Malaya, Kuala Lumpur, Malaysia
2University of Malaya Medical Centre, Kuala Lumpur, Malaysia

Introduction:

Airway malacia is a potentially serious disorder that is encountered in children with noisy breathing, recurrent pneumonia and chronic cough. Management challenges include delayed diagnosis or misdiagnosis and limited treatment options.

Objectives:

This study aimed to determine the prevalence, clinical characteristics and outcome of children diagnosed with malacic airway. 

Methodology:

This retrospective study was conducted among children aged <18 years, who were diagnosed with airway malacia through flexible bronchoscopy (FB), from January 2014 to December 2022. Children with isolated laryngomalacia and incomplete data were excluded. 

Results:

Eighty-five patients with a median age of 6.9 months were recruited, 67.1% were males. The commonest indications for FB were recurrent pneumonia and persistent stridor, both were 18.8%.  The prevalence of airway malacia was 37%. The commonest presentations were ventilator dependence (62.4%), recurrent pneumonia (50.6%) and apnoea/cyanotic spells (21.2%). Half (50.6%) had tracheomalacia (TM), 31.8% had trachea-bronchomalacia (TBM) and 17.6% had bronchomalacia (BM).  Stridor was only present in malacia involving the trachea (TM & TBM), p=0.004. One third had severe malacia (obstruction> 90%). The overall mortality was 13% (n=11). One third (35.3%) required home respiratory support for a median duration of 5 months. TBM or BM was associated with a higher mortality (OR 6.1, 95% CI 1.3-44.1, p=0.02) and increased need for invasive home ventilation (OR 6.1, 95% CI 1.3-44.1, p=0.02). Conclusion: Paediatric airway malacia was found in one-third of children undergoing bronchoscopy. TM was the commonest finding. Mortality and need for invasive home ventilation were higher in children with TBM or BM.