BACKGROUND:Bleeding is a well-recognized complication in flexible bronchoscopy, especially with advanced procedures. Oxymetazoline is a topical vasoconstrictor often used to reduce or treat bleeding in the nares and airways. METHODS:A retrospective cohort study was conducted on pediatric patients undergoing flexible bronchoscopy from 2015 to 2025. Language processing was used to analyze bronchoscopy-related procedures, and mixed-effects logistic regression models were used to compare blood pressure, heart rate, and rescue medication use in cohorts that were exposed to nasal, endobronchial, and no oxymetazoline. RESULTS:A total of 2874 patients (41% female, mean age: 5.8 y) underwent 3978 bronchoscopies, 66 (2%) of which were exposed to endobronchial oxymetazoline and 1039 (26%) to nasal oxymetazoline. Endobronchial oxymetazoline was associated with higher systolic blood pressure (β=5.73; 95% CI: 2.48-8.98; P=0.00067), diastolic blood pressure (β=3.68; 95% CI: 1.41-5.96; P=0.0016), and lower heart rate (β=-6.91; 95% CI: -10.84 to -3.00; P=0.00054). These effects were more pronounced when bleeding was reported. Endobronchial oxymetazoline was associated with increased bradycardia (OR: 1.92; 95% CI: 1.09-3.40; P=0.024), but not with increased rescue medication use (OR: 0.69; 95% CI: 0.38-1.24; P=0.21). CONCLUSION:Endobronchial and nasal oxymetazoline use during pediatric flexible bronchoscopy is associated with a mild increase in blood pressure and a decrease in heart rate, although it is well-tolerated and appears to be safe without an increased need for clinical intervention.

OBJECTIVE:A tracheoesophageal fistula (TEF) is an abnormal communication between the esophagus and trachea, most often associated with esophageal atresia (EA), a rare congenital malformation affecting 1 in 2400-4500 live births. While surgical repair of EA/TEF is typically completed in infancy, recurrent or missed TEF can be diagnosed later. Open repair can be technically challenging, often requiring re-do thoracotomy or neck dissection. We describe our center's experience, using endoscopic electrocautery in combination with esophageal clips for closure of TEF. METHODS:We conducted a retrospective review of all patients who underwent an endoscopic TEF repair with esophageal clip application at our institution (IRB# 20-021016). All patients underwent triple endoscopy (flexible bronchoscopy, esophagogastroduodenoscopy, and rigid bronchoscopy) with pulmonary, gastroenterology (GI), and otolaryngology (ENT). Electrocautery was performed on the tracheal side by ENT or pulmonary and esophageal clip placement by GI. RESULTS:Between November 2019 and February 2025, 14 patients underwent successful endoscopic closure of 15 TEF. One patient failed endoscopic closure of a proximal missed congenital TEF but had successful endoscopic closure of their recurrent TEF. Ten TEF were closed with electrocautery and esophageal clip placement while five were closed with cautery alone. No significant complications occurred, and all closures were confirmed with follow-up endoscopy. CONCLUSION:Endoscopic electrocautery with esophageal clip application, by a skilled multidisciplinary team, offers a minimally invasive alternative to open repair for missed congenital, recurrent, and acquired TEFs. It may be considered as a first line approach, especially in patients with high surgical risk.

RATIONALE:Cryotherapy and its diagnostic analogue, cryobiopsy, are emerging techniques via bronchoscopy with a wide range of clinical applications. While the use of cryotherapy and cryobiopsy has been established in adult pulmonary medicine, pediatric data describing the indications, procedural specifics, outcomes, and complications are limited. OBJECTIVE:To describe the indications, procedural specifics, outcomes, and complications of cryotherapy and cryobiopsy use in pediatric bronchoscopy. METHODS:A multicenter retrospective observational study was conducted at 5 pediatric hospitals in the United States. Patients aged 0 to 21 years who underwent cryotherapy or cryobiopsy via bronchoscopy between January 2017 and January 2025 were included. RESULTS:A total of 317 cryotherapy and cryobiopsy procedures were performed in 187 patients (median age 10 [3, 15] years; 44% female). The most common indication was cryoextraction (50%), followed by cryorecanalization (38%) and cryobiopsy (17%). The 1.1-mm cryoprobe was used in 57% of cases. Cryoextraction was at least partially successful in 95% of procedures, with the most common use being removal of blood clots (57%). Cryorecanalization was at least partially successful in 93% of procedures. The use of cryobiopsy has grown the most over the past 2 years. Cryobiopsy yielded successful histopathologic evaluation in 96% of biopsy specimens with 73% diagnostic yield. Bleeding was the most common complication of cryotherapy, occurring in 35% of cases, with 96% being grade 1 or 2. No pneumothorax was observed. Other complications were rare. CONCLUSIONS:Cryotherapy and cryobiopsy via bronchoscopy in pediatrics have been increasingly used, demonstrating high success and a favorable safety profile. The introduction of the 1.1-mm cryoprobe has facilitated its broader application to pediatrics. Bleeding was the most common complication but was generally mild in the context of the selected cases at specialized centers.

Introduction Air leak is a common complication of necrotizing pneumonia in critically ill children. Severe air leaks impact effective oxygenation and ventilation, oftentimes necessitating multiple thoracostomy tubes and extracorporeal support. Endobronchial valves (EBV) are a minimally invasive intervention to control air leak that may expedite de-escalation of care for critically ill children with necrotizing pneumonia.Methods A retrospective case series was conducted on patients at the Children's Hospital of Philadelphia who were hospitalized in the pediatric intensive care unit, required extracorporeal membrane oxygenation (ECMO), and underwent placement of one or more EBVs for air leak from July 2023 through August 2024.Results Six patients, median age 12 years (range 18 months to 18 years), were hospitalized for necrotizing pneumonia complicated by severe air leak and required ECMO. The most common etiology was a viral infection with bacterial co-infection. The median number of EBVs placed per patient was five. The median total time on ECMO was 10 days, with a median duration of 3.5 days after valve placement. The median duration of antibiotic therapy was 47 days (range 24 to 126 days). One patient had a contralateral pneumothorax after valve placement, and another died due to progression of multiorgan failure that began before EBV placement. The five surviving patients were discharged from the hospital, weaned from all respiratory support, and their valves were removed without complication.Conclusion Endobronchial valves are a feasible intervention for severe air leak in critically ill children with necrotizing pneumonia and may expedite liberation from ECMO.

The American Thoracic Society Core Curriculum updates clinicians annually in relevant topics related to pediatric pulmonary diseases. This is a summary of the Pediatric Pulmonary Medicine Core Curriculum presented at the 2024 American Thoracic Society International Conference. The curriculum focused on clinical topics that are essential to caring for patients in the intensive care unit (ICU), highlighting the specific care of patients with severe asthma, pediatric acute respiratory distress syndrome (PARDS), hemoptysis and pulmonary hemorrhage, serious cardiovascular disease within the cardiac ICU and chronic respiratory failure. In the case of severe asthma, we review risk factors for ICU admission, adjunct pharmacologic therapies and appropriate ventilatory strategies. We discuss the highlights of the recently updated PARDS guidelines are offer further diagnostic stratification including possible and at risk categories to help facilitate early intervention and possibly prevent disease progression. Though relatively rare, pediatric hemoptysis and pulmonary hemorrhage can be devastating clinical scenarios and this review includes the discussion of pharmacologic and bronchoscopic interventions that should be considered in these cases. Additionally, we provide a summary of some of the common respiratory pathophysiology encountered in the cardiac ICU, as well as the diagnostic and therapeutic interventions available to the pulmonologist. Lastly, we review the decision-making considerations when transitioning patients from the ICU to chronic home mechanical ventilation. This manuscript aims to provide basic knowledge regarding each of these topics, in addition to up-to-date literature and resources for practicing pulmonologists and trainees.

INTRODUCTION:Bronchopulmonary dysplasia (BPD) is a major complication of prematurity, marked by heterogeneous pulmonary phenotypes and variable clinical outcomes. The airway microbiome may influence disease severity and progression, yet quantitative associations between airway pathogens and clinically relevant outcomes remain poorly understood. METHODS:We conducted a retrospective analysis of 204 neonates who underwent flexible bronchoscopy with quantitative bronchoalveolar lavage (BAL) cultures in the NICU at the Children's Hospital of Philadelphia. Cultures yielding ≥ 10,000 colony-forming units per milliliter for a single bacterial species were classified as positive. Respiratory severity score (RSS), calculated as the product of mean airway pressure and fraction of inspired oxygen, served as the primary indicator of respiratory status. Linear, logistic, and negative binomial regression models were used to assess associations between bacterial species and clinical outcomes, adjusted for sex and race, with standard errors clustered at the patient level. RESULTS:No bacterial species were significantly associated with RSS after correction for multiple testing. Klebsiella pneumoniae was associated with a diagnosis of BPD (adjusted p = 0.026), but no organisms were significantly associated with prolonged time to extubation. In secondary analyses, the presence of several organisms was significantly associated with higher MAP, including K. pneumoniae (β = 2.66, FDR-adjusted p = 0.014). CONCLUSIONS:Multiple bacterial species identified on quantitative BAL culture were associated with higher mean airway pressure, and K. pneumoniae was additionally associated with BPD diagnosis. These findings support the potential utility of quantitative microbiologic data in risk stratification and management of neonatal respiratory disease.

IntroductionTracheomalacia (TM) is an important cause of respiratory morbidity. Dynamic flexible bronchoscopy is considered the gold standard for diagnosis. Dynamic airway computed tomography (DACT) is a low radiation, noninvasive diagnostic tool utilizing images obtained continuously over several respiratory cycles. We aimed to assess the accuracy of DACT in TM diagnosis.MethodsRetrospective analysis of all patients who underwent both DACT and flexible bronchoscopy within 6 months. Airway anterior-posterior (AP) diameter was measured on multiplanar reconstructions CT in both the inspiratory and expiratory phases. Using still images from the bronchoscopy videos, the AP diameter of the trachea was measured at points of maximal and minimal diameter during tidal breathing. Degree of TM on both DACT and flexible bronchoscopy were graded using a scaling system of 50%-74%, 75%-89%, and 90%-100% as described by the European Respiratory Society.ResultsTwenty-four patients met inclusion criteria with an average time of 19.5 days between CT and bronchoscopy. The specificity and sensitivity of DACT for the overall diagnosis of TM was 100% and 68%, respectively, with a positive predictive value of 100% and a negative predictive value of 62%. There was a strong positive correlation between DACT and flexible bronchoscopy in the measurement of tracheal AP diameter changes (rho = 0.773, R2 0.597, p = 0.00001). Mean effective radiation dose for DACT was 0.1 mSv.ConclusionUltralow dose DACT has excellent specificity and positive predictive value for both detection of TM and categorizing severity of tracheal collapse but is not sufficiently sensitive to rule it out.

Objective: Endobronchial ultrasound-guided transbronchial biopsy and needle aspiration (EBUS-TBB/EBUS-TBNA) are first line investigative modalities for lung and mediastinal pathology in adults. We aimed to characterize and assess the diagnostic yield of EBUS and virtual CT navigation guided biopsies in children.Study Design: This single center, retrospective cohort study included patients who underwent radial or linear EBUS procedures (+/- CT navigation) for biopsy of mediastinal lymph nodes, tumors, and pulmonary nodules. Demographic, procedural, and outcome were collected.Results: Sixty procedures were performed in 56 patients aged 2-22 years of age between January 2015 and May 2023. The most common indications for biopsy were pulmonary nodules (45%) and hilar/mediastinal lymphadenopathy (33%). For cases in which a final diagnosis was ascertained by any means, the diagnostic yield for linear EBUS (mediastinal pathology) was 76% and the diagnostic yield from radial EBUS (pulmonary nodules and lung masses) was 85%. The most common diagnoses were infection (45%), malignancy (17%), and sarcoidosis (11%). Among patients in whom infection was the final diagnosis, a total of 31 pathogens were identified. Eighteen were identified on bronchoalveolar lavage and an additional 14 pathogens identified on EBUS-TBB, representing an increase of 77% (p < .005). The sensitivity, specificity, negative and positive predictive values for malignancy detection were 73%, 100%, 94%, and 100%, respectively.Conclusion: EBUS-TBB/TBNA is a safe and effective way to diagnose lung and mediastinal pathology in children. Pediatric interventional pulmonology is a growing field offering minimally-invasive diagnostic opportunities for children in whom more invasive procedures were previously the only option.

BackgroundThe aim of our study was to investigate the prevalence of coexisting conditions and exposures in children with nodular tracheobronchitis diagnosed by flexible bronchoscopy.MethodsWe conducted a single-center retrospective review of 100 children diagnosed with nodular tracheobronchitis by flexible bronchoscopy between 2012 and 2023.ResultsCommon coexisting diagnoses included gastroesophageal reflux disease (GERD, 50%), dysphagia/aspiration (40%), asthma (30%), recurrent croup (30%), tracheostomy dependence (19%) and eosinophilic esophagitis (EOE) (12%). Bronchoalveolar lavage (BAL) demonstrated cellular inflammation with elevated proportions of neutrophils in 63%, and lymphocytes in 24%. Among 88 patients in whom bacterial cultures were performed, 52% were positive, with Moraxella, Haemophilus, Streptococcal and Pseudomonas species predominating. Among 30 patients who underwent viral testing, 57% were positive, with rhinovirus (82%) and adenovirus (29%) predominating. Patients with neutrophilic inflammation were more likely to have a positive respiratory bacterial culture and/or viral polymerase chain reaction (p = 0.003, 0.005). Evaluation of the gastrointestinal tract included 79 patients with a history of esophagogastroduodenoscopy, 45 patients with a videofluoroscopic swallow study (VFSS), and 45 patients with multi-channel intraluminal impedance and pH testing. The majority of VFSS were abnormal (60%) demonstrating either laryngeal penetration (33%) or intratracheal aspiration (27%). Median pH reflux and impedance proximal reflux indices were 3.8% and 0.5% respectively.ConclusionPotential contributing factors in the pathophysiology of nodular tracheobronchitis include bacterial and viral infections, GERD, dysphagia/aspiration, and EOE. When nodular tracheobronchitis is observed during bronchoscopy, further evaluation to assess for these conditions should be considered.

Pediatric PulmonologyVolume 59, Issue 4 p. 1089-1091 CLINICAL CORRESPONDENCE Pediatric miliary tuberculosis diagnosed by endobronchial ultrasound-guided biopsy Lauren M. C. Grant MD, Corresponding Author Lauren M. C. Grant MD [email protected] orcid.org/0009-0004-7993-3256 Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Correspondence Lauren M. C. Grant, MD, Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Email: [email protected]Search for more papers by this authorNoran Hassan MBBS, PhD, Noran Hassan MBBS, PhD Department of Pediatrics and Neonatology, Cairo University Children's Hospital, El Sayeda Zeinab, Egypt Contribution: ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorJeffrey S. Gerber MD, PhD, Jeffrey S. Gerber MD, PhD Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Contribution: Writing - review & editing, SupervisionSearch for more papers by this authorPelton A. Phinizy MD, Pelton A. Phinizy MD Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Contribution: Writing - review & editing, SupervisionSearch for more papers by this authorJoseph Piccione DO, MS, Joseph Piccione DO, MS Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Contribution: Writing - review & editing, SupervisionSearch for more papers by this author Lauren M. C. Grant MD, Corresponding Author Lauren M. C. Grant MD [email protected] orcid.org/0009-0004-7993-3256 Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Correspondence Lauren M. C. Grant, MD, Division of Pulmonary & Sleep Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA. Email: [email protected]Search for more papers by this authorNoran Hassan MBBS, PhD, Noran Hassan MBBS, PhD Department of Pediatrics and Neonatology, Cairo University Children's Hospital, El Sayeda Zeinab, Egypt Contribution: ​Investigation, Writing - original draft, Writing - review & editingSearch for more papers by this authorJeffrey S. Gerber MD, PhD, Jeffrey S. Gerber MD, PhD Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Contribution: Writing - review & editing, SupervisionSearch for more papers by this authorPelton A. Phinizy MD, Pelton A. Phinizy MD Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Contribution: Writing - review & editing, SupervisionSearch for more papers by this authorJoseph Piccione DO, MS, Joseph Piccione DO, MS Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Contribution: Writing - review & editing, SupervisionSearch for more papers by this author First published: 19 January 2024 https://doi.org/10.1002/ppul.26878Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES 1Geweniger A, Janda A, Eder K, et al. High diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of adolescent pulmonary tuberculosis. BMC Infect Dis. 2021; 21(1): 946. 10.1186/s12879-021-06413-z PubMedWeb of Science®Google Scholar 2Madan K, Iyer H, Madan NK, et al. Efficacy and safety of EBUS-TBNA and EUS-B-FNA in children: a systematic review and meta-analysis. Pediatr Pulmonol. 2021; 56(1): 23-33. 10.1002/ppul.25124 PubMedWeb of Science®Google Scholar 3Al-Najjar H, Breen R, Santis G, Narayan O. The utility and safety of linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the paediatric population. Eur Respir J. 2020; 55(4):1902277. 10.1183/13993003.02277-2019 PubMedWeb of Science®Google Scholar 4Dhooria S, Madan K, Pattabhiraman V, et al. A multicenter study on the utility and safety of EBUS-TBNA and EUS-B-FNA in children. Pediatr Pulmonol. 2016; 51(10): 1031-1039. 10.1002/ppul.23415 PubMedWeb of Science®Google Scholar Volume59, Issue4April 2024Pages 1089-1091 ReferencesRelatedInformation

The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

This case of a child presenting with severe acute respiratory failure requiring extracorporeal membrane oxygenation due to plastic bronchitis demonstrates the possibility of developing this rare condition despite having no known underlying inflammatory or lymphatic issues. The normal lymphatic anatomy and flow in our patient several weeks after the acute illness suggests a transient lymphatic flow abnormality possibly driven by the acute lower respiratory tract infection with human bocavirus-1 (HBoV1). As there are now four patients in the literature identified with Plastic bronchitis (PB) in the setting of HBoV1, it may be beneficial to include HBoV1 in the initial workup of patients with unknown etiology of PB. While routine use of MR lymphangiography is not warranted, we wonder if the procedure might help realize lymphatic flow abnormalities crucial to the pathophysiology if it can be performed safely in the acute setting. The heterogeneous population presents a challenge when studying PB, thus future studies are needed to elucidate the complex pathophysiology, guide management, and better understand prognosis.

Bacterial cultures from tracheal aspirates (TA) and bronchoalveolar lavage (BAL) specimens can be used to assess patients with artificial airways for lower respiratory tract infections (LRTI). TA collection may be advantageous in situations of limited resources or critical illness. Literature comparing these diagnostic modalities in pediatric populations is scarce.

Objectives To evaluate the prevalence of hemosiderin-laden macrophages in children with bronchopulmonary dysplasia (BPD) and assess for an association between hemosiderin-laden macrophages and pulmonary arterial hypertension. Study design Retrospective case-control study of infants and children with and without BPD who underwent bronchoscopy with bronchoalveolar lavage (BAL) the at Children's Hospital of Philadelphia between 2012 and 2021. Results BAL from 205 children with BPD and 106 controls without BPD matched for tracheostomy, infection, and age were reviewed for hemosiderin-laden macrophages. Seventy-one individuals (34.6%) with BPD had a BAL with 10% or more hemosiderin-laden macrophages compared with 3 (2.8%) controls (P < .0001; OR, 18.19; 95% CI, 5.57-59.41). Patients with pulmonary hypertension by echocardiogram (P = .04; OR, 3.69; 95% CI, 1.05-12.96) or an elevated mean pulmonary artery pressure during cardiac catheterization, r(s) (14) = 0.56, P = .04, were more likely to have elevated hemosiderin-laden macrophages on BAL samples less than 60 days from bronchoscopy. After adjusting for birth weight, gestational age, BPD grade, and age at the time of bronchoscopy using logistic regression, pulmonary hypertension was associated with a higher odds of hemosiderin-laden macrophages of 10% or more (P = .02; OR, 6.37; 95% CI, 1.28-31.87). No association was observed between hemosiderin-laden macrophages and sex, race, gestational age, birth weight, tracheostomy, or infectious studies. Conclusions This retrospective study revealed increased hemosiderin-laden macrophages in BAL samples from patients with BPD and a significant association with pulmonary arterial hypertension. It is unclear whether elevated hemosiderin-laden macrophages within BPD contributes to the pathogenesis of lung and pulmonary vascular disease or is simply a biomarker of pulmonary arterial hypertension.

For mastering bronchoscope handling, positioning, and directing of the bronchoscope in response to the intraluminal view provided by the bronchoscope camera, sufficient training is necessary, especially in infants and toddlers who have smaller airways, faster respiratory rates, and higher airway collapsibility. With the use of three-dimensional printing, we aimed to develop a set of anatomically accurate and low-cost airway models for teaching and training of bronchoscopy technique and foreign body removal: a translucent airway box model, a static airway model, and a dynamic airway model consisting of a flexible tree model connected to a pump that allows simulation of airway collapsibility during breathing. Computed tomography (CT) patient data of three different ages (1, 5, and 18 years of age) was imported into Materialise Mimics, segmented, and printed using VisoClear and soft Tango+ material. The models were evaluated by three pediatric pulmonology attendings for anatomical accuracy and usefulness for teaching and training. The translucent airway box model was preferred for the initial presentation of bronchoscope handling and learning anatomy in three dimensions. The static and flexible tree models were used to train bronchoscope handling and foreign body removal. The dynamic model provided the most realistic representation of a pediatric airway throughout the respiratory cycle with increased patency during inspiration and relative collapse during exhalation. Objective verification of anatomical accuracy and physiology of breathing motion was obtained by comparing CT scans of the model with original images and by application of 4D dynamic CT airway imaging protocols, respectively.

Laryngotracheoesophageal clefts (LTECs) and tracheoesophageal fistulae (TEF) are important structural causes of aspiration requiring bronchoscopy for diagnosis. Determining which children are at greatest risk for LTEC and TEF would enable clinicians to be more selective in performing bronchoscopy. METHODS:Medical records of children aged 0-18 years who underwent flexible and rigid bronchoscopy for evaluation of dysphagia with aspiration were collected and analyzed to identify predictors of LTEC and TEF. RESULTS:Seventy-two children age 2 months to 9 years were identified. LTEC was identified in 19 (26%) and TEF was identified in 1 (1.3%). One-third of the cohort was born preterm (median gestational age 34 weeks). The proportion of LTEC in those born preterm was lower than that of those born full-term (12% vs. 34%, p = .03). 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 videofluoroscopic swallowing studies. Bronchoalveolar lavage fluid cytology, lipid-laden macrophage proportions, and culture results were similar among those with and without LTEC. CONCLUSION:Children with dysphagia and tracheal aspiration born full-term are three 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.