Study finds, Various Clinical Predictors of Laryngotracheoes
The structural causes of aspiration, laryngotracheoesophageal clefts (LTEC) and tracheoesophageal fistulae (TEF), necessitate bronchoscopy for diagnosis. Identifying which children are most vulnerable to LTEC and TEF would allow clinicians to be more selective in their bronchoscopy procedures.

Medical records of children aged 0 to 18 years who underwent flexible and rigid bronchoscopy for evaluation of dysphagia with aspiration were collected and analyzed to identify predictors of LTEC and TEF.

--72 children age 2 months to 9 years were identified. LTEC was identified in 19 and TEF was identified in 1.

--One-third of the cohort was born preterm. The proportion of LTEC in those born preterm was lower than that of those born full term.

--There was no statistically significant difference in LTEC prevalence based on age, midline defects, laryngomalacia, tracheomalacia, history of TEF repair, silent aspiration, or viscosity of barium aspirated during video fluoroscopic swallowing studies.

--Bronchoalveolar lavage fluid cytology, lipid laden macrophage proportions, and culture results were similar among those with and without LTEC.

In particular, Children with dysphagia and tracheal aspiration born full term are 3 times more likely to have LTEC than those born preterm. Dysphagia in children with a history of preterm birth is more likely to be functional as opposed to structural, however, LTEC was identified in approximately 10% of these children and must be considered. These results support the role of bronchoscopy in children with dysphagia with tracheal aspiration.