Bronchoscopy findings in children and young adults with tracheostomy due to congenital anomalies and neurological impairment

Issue title: Cerebral Palsy

Article type: Research Article

Authors: Kharasch, Virginia S.^; | Dumas, Helene M. | Haley, Stephen M. | Sawicki, Gregory S. | Ludlow, Larry H. | Wright, Erika A. | Jones, Dwight T. | O'Brien, Jane E.

Affiliations: Department of Pulmonology, Franciscan Hospital for Children, Boston, MA, USA | Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA | Research Center for Children with Special Health Care Needs, Franciscan Hospital for Children, Boston, MA, USA | Health and Disability Research Institute, Boston University, Boston, MA, USA | Department of Educational Research, Measurement and Evaluation, Lynch School of Education, Boston College, Boston, MA, USA | Department of Otorhinolaryngology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA | Medical Director, Franciscan Hospital for Children, Boston, MA, USA

Note: [] Address for correspondence: Helene Dumas PT, MS, Research Center, Franciscan Hospital for Children, 30 Warren Street, Boston, MA 02135, USA. E-mail: [email protected]

Abstract: The aim of this study was to examine bronchoscopy findings for children and young adults with long-term tracheostomies due to congenital anomalies and neurological impairment and identify characteristics associated with abnormal bronchoscopic findings. We conducted a retrospective study of 128 bronchoscopy cases (81 children) at a pediatric rehabilitation center. Thirty-eight cases (30%) had normal findings and 14 children (17% of all children) were decannulated following bronchoscopy. Ninety cases (70% of cases) had abnormal findings (e.g. granulomas, airway inflammation, fixed obstruction). An acute indication for bronchoscopy was the strongest predictor of an abnormal finding, while age (younger) and diagnosis (multiple congenital anomalies (MCA)) also were associated with abnormalities. For a subsample of children undergoing bronchoscopy for routine surveillance (n= 90), underlying diagnosis (MCA) was the strongest predictor of an abnormal finding, while younger age contributed slightly. These findings add to the limited literature describing bronchoscopic findings in children and youth with tracheostomies due to congenital anomalies or neurological impairment. These findings may be useful for rehabilitation clinicians in determining care needs for children with long-term tracheostomy.

Keywords: Bronchoscopy, children, congenital anomaly, neurological, tracheostomy

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 1, no. 2, pp. 137-143, 2008