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Airway obstruction and inflammation on combined bronchoscopy in children with Down syndrome
Author(s) -
Vielkind Monica,
WolterWarmerdam Kristine,
Jackson Arwen,
Maybee Jennifer,
Brown Mark,
Friedlander Joel,
Friedman Norman,
Hickey Francis,
Prager Jeremy,
Wine Todd,
DeBoer Emily
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25573
Subject(s) - medicine , tracheomalacia , interquartile range , bronchoalveolar lavage , laryngomalacia , bronchoscopy , dysphagia , tracheobronchomalacia , airway , retrospective cohort study , subglottic stenosis , airway obstruction , pediatrics , surgery , stridor , lung
Objective To characterize the upper and lower airway findings in children with Down syndrome and chronic respiratory symptoms, based on evaluation by flexible bronchoscopy (FB) with bronchoalveolar lavage and microlaryngoscopy with bronchoscopy (MLB). Study design A retrospective review was conducted of children with Down syndrome aged 1 month to 17 years, who underwent both FB and MLB within a 1‐year timeframe between 2010 and 2019 at Children's Hospital Colorado. Anatomic airway findings are reported as frequencies within the cohort. Bronchoalveolar lavage fluid (BALF) culture results, cell differential, and cytopathology are reported as frequencies or mean ± standard deviation. BALF results were compared between children with and without dysphagia documented on a recent swallow evaluation. Results Overall, 168 children with Down syndrome were included, with median age of 2.1 years (interquartile range: 0.9–5.1 years). At least one abnormal airway finding was recorded in 96% of patients and 46% had at least three abnormal findings. The most common findings included tracheomalacia (39% FB; 37% MLB), subglottic stenosis (35% MLB), pharyngomalacia (32% FB), and laryngomalacia (16% FB; 30% MLB). Comparison of BALF based on dysphagia status showed that children with dysphagia had more frequent cultures positive for mixed upper respiratory flora (76% vs. 47%, p = 0.004) and a higher percentage of neutrophils (20% vs. 7%, p = 0.006). Conclusion Abnormal findings for FB and MLB are common in children with Down syndrome and chronic respiratory symptoms, and performing the procedures together may increase the diagnostic yield.