TRACHEOBRONCHIAL DYSKINESIA IN PEDIATRIC- PATIENTS (A REVIEW OF 37 CASES)

Tracheobronchial dyskinesia (TBD) was diagnosed by fiberoptic bronchos copy (89%) and/or image intensifier radiography of the airways in 37 p ediatric patients admitted between January 1, 1987 and December 31, 19 91 to a pediatric intensive care unit or a pneumology day care unit. A ge ranged from two months to nine years (mean age 16 months); 70% of p atients were younger than one year at admission. Sixty-two percent of the patients were male, and 35% had a history of prematurity. Reasons for admission were recurrent respiratory infections (30%), continuatio n of mechanical ventilation started during the neonatal period (27%), an apparently life-threatening event (18.5%), acute respiratory distre ss (13.5%), and chronic strider or crowing (11%). Tracheal. dyskinesia was found in 91% of cases and was the only abnormality in 52%. Isolat ed bronchial dyskinesia was seen in 9% of cases. The main causes of ai rway dyskinesia included neonatal mechanical ventilation (40.5%), vasc ular abnormalities (16%), and esophageal atresia with tracheoesophagea l fistula (11%). Esophageal reflux was demonstrated by esophageal pH r ecording in 54% of patients. Fiberoptic bronchoscopy, which is feasibl e even in premature infants, is the mainstay of diagnosis and also all ows to evaluate the severity and extent of the dyskinesia and, in some instances, to suspect a cause. Volumetric spiraled computed tomograph y is useful in secondary TBD. Management rests on chest physiotherapy, antimicrobials for respiratory tract infections, and conservative or, if needed, surgical treatment of gastroesophageal reflux, if present. Specific treatment may be needed to eliminate a cause (e.g., compress ion by an abnormal vessel). Positive expiratory pressure ventilation ( either controlled or spontaneous) is useful in some severe cases. Aort opexy deserves consideration in some patients; the value of stents rem ains to be evaluated. Primary moderate TBD usually resolves during the second year of life.