Utility of interval direct laryngoscopy and bronchoscopy in tracheostomy-dependent infants: A retrospective longitudinal chart review.

Background: Tracheostomies are increasingly utilized in children with respiratory compromise, necessitating routine direct laryngoscopy and bronchoscopy (DLB) to confirm airway patency and manage complications. The timing and frequency of interval DLB in children lack consensus due to insufficient evidence-based data. Our study aims to evaluate the utility of interval DLB in tracheostomy-dependent infants.

Methods: Retrospective case-series of infants who underwent tracheostomy at ≤ 2 years of age at a tertiary children's hospital, with at least 1 year of follow-up.

Results: There were 52 patients who underwent 430 DLBs. Median age at time of tracheostomy was 5.29 [4.72] months. Most patients were male (n = 29, 55.8 %) and white (n = 22, 42.3 %). Significant comorbidities included hypotonia (n = 40, 79.9 %), bronchopulmonary dysplasia (n = 29, 55.8 %), syndromic/genetic disorders (n = 26, 50.0 %), and structural cardiac abnormalities (n = 22, 42.3 %). Median gestational age was 34 ± 6.2 [IQR = 13] weeks. A median interval of 5.29 [IQR = 4.63] months occurred between DLBs. Common surgical interventions included intra-luminal granulation tissue removal and endoscopic dilation with overall intervention rates of 26.8 %, 37.5 %, 28.6 %, 26.8 %, 25.0 %, and 17.9 % on DLB 1-6, respectively. An intervention in DLB2 (6.2 months) or DLB3 (10.6 months) was associated with a higher percent intervention in subsequent DLBs during the study period (p = 0.002). Other comorbidities such as age at tracheostomy, mechanical ventilation, and gestational age were not associated with a greater need for intervention.

Conclusions: Interval DLB in tracheostomy-dependent infants frequently involves surgical interventions, regardless of demographic or medical factors, underscoring the role of surveillance DLB.