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Objectives:Flexible fiberoptic bronchoscopy (FB) is one of the methods used for the diagnosis of childhood respiratory diseases. This diagnostic method allows the examination of the nose, pharynx, larynx and tracheobronchial tree. In this study, we aimed to present our five-year FB experience and to draw attention to the diagnostic benefit of FB in childhood.Materials and Methods:We retrospectively evaluated the indications and results of 316 FB procedures performed in our center between March 1, 2014 and March 1, 2019. Patients’ age, gender, chronic diseases, indication of FB, route of administration, size of bronchoscopy used, microbiological and cytological examination results of bronchoalveolar lavage liquid, pathological bronchoscopic findings, diagnosis and complications during bronchoscopy were examined.Results:In the five-year period, a total of 300 patients underwent 316 FB procedures. One hundred and seventy of 316 FB patients that were evaluated (53.7%) were boys. The median age of the patients was 48 months. The most common indications for bronchoscopy were atelectasis (n=68, 21.5%), chronic cough (n=53, 16.8%) and stridor (n=42, 13.3%). Diagnostic findings were obtained during bronchoscopy in 235 (74.4%) patients. Fifteen (4.7%) patients developed minor complications and 10 (3.4%) of these patients had short-term hypoxemia during the procedure.Conclusion:FB in childhood is a method that can be performed with many indications in patients with respiratory symptoms. Adequate preparation prior to the procedure and careful monitoring of the patient by a trained team during the procedure are crucial for the safe completion of the procedure.

Case Presentation A 2-year-old boy was referred to the Ankara University School of Medicine Children’s Hospital with a history of recurrent respiratory distress and cyanosis since birth. His medical history was significant for premature birth at 31 weeks via cesarean section, as an infant of a diabetic mother. There was no parental consanguinity. He was hospitalized in the neonatal ICU after birth because of respiratory distress. After receiving invasive mechanical ventilation for 4 days, noninvasive mechanical ventilation and oxygen therapy were given gradually. As a result of further investigations, he received a diagnosis of situs inversus totalis and pulmonary hypertension. He was discharged on postnatal day 53 without supplemental oxygen therapy or treatment for pulmonary hypertension. Up to the age of 2 years, the patient had a history of multiple admissions to hospital for respiratory distress, lower respiratory tract infection, and cyanosis as an inpatient and outpatient. After starting to walk, shortness of breath and coughing occurred with effort.

Airway malacia is a condition of excessive airway collapsibility during expiration. As it may lead to life threatening events and even death in children, it is important to recognise and treat this disorder. In this study, we aimed to evaluate clinical features, prognoses, and associated disorders of the patients with lower airway malacia. In a total of 390 patients and 410 bronchoscopies, lower airway malacia was diagnosed in 65 (16.6%) children between 2014 and 2020. Demographic and clinical features, video image records of bronchoscopy and prognoses of the patients were evaluated retrospectively. The median age was 1 year and 2 months. Thirty-five (53.8%) of the patient were male. The numbers of children with isolated tracheomalacia, isolated bronchomalacia and tracheobronchomalacia were nine (13.8%), 48 (73.8%) and eight (12.3%), respectively. The localizations of airway malacias are shown in Table 1. The distinction of cause of admission and physical examination findings according to the type of malacia is shown in Table 2. Fifty-eight (89.2%) patients had other co-morbidities associated with airway malacia (Table 3). Inhaled ipratropium bromide therapy was started for 37 (56.9%) patients and terminated in four patients because of clinical improvement yet the others continued to treatment. Ten (15.4%) patients required continuous positive pressure support. Three patients (4.6%) died during follow-up. Lower airway malacia is an important disorder in children with respiratory problems and flexible bronchoscopy is a valuable diagnostic method. In patients with atypical respiratory findings and no response to treatment, lower airway malacia should be kept in mind.

OBJECTIVES The number of children on home mechanical ventilation (HMV) has increased. Understanding the reasons for nonscheduled hospital admissions during HMV is critical. This study aims to investigate the risk factors of first nonscheduled hospital admissions of pediatric patients on HMV. METHODS A retrospective analysis of patients on HMV between May 1, 2014 and October 1, 2020 was performed. Patients' demographic characteristics, duration of the education of the primary caregiver; time of first nonscheduled visit; and type of HMV (noninvasive mechanical ventilation [NIV] or invasive mechanical ventilation [IMV]) were analyzed. The reasons for first nonscheduled hospital visits were categorized as respiratory problems and other reasons. RESULTS Of 97 patients, 41 were female (42.3%), and 70 (72%) were on IMV. The median age was 23 months (IQR, 10-91). Twenty-nine patients (30%), were admitted to hospital before scheduled visit with a mean duration of 18.1 ± 11.6 days; of them, 14 (48.2%) admitted because of respiratory problems. IMV increases the risk of first nonscheduled visit compared to NIV (OR, 16.3; 95% CI, 2.1-127.4; p = .008). If a caregiver spends less than 14 days in hospital for education, risk of nonscheduled visits increases (OR, 4.0; 95% CI, 1.5-11.2; p = .007). CONCLUSION A minimum 14 days seems to be necessary for education of the caregivers of the patients with HMV to reduce the number of nonscheduled visits, which is a burden for both patients and healthcare system.

Background: Airway malacia is a condition of excessive airway collapsibility, which causes expiratory reduction in the cross-sectional luminal area during respiration. As this disorder may lead to life threatening events and even death in children, it is important to recognise and treat it. Aims: In this study, we aimed to evaluate clinical and radiological features, prognoses, and associated disorders of the patients with lower airway malacia. Methods: A total of 65 patients with lower airway malacia diagnosed by flexible bronchoscopy were included in this study. Demographic and clinical features, radiological findings, video image records of bronchoscopy and prognoses of the patients were evaluated retrospectively. Results: Lower airway malacia was diagnosed in 65 (16.6%) children with a median age of 1 year and 2 months (range: 1 month-16 years and 8 months). Thirty-five (53.8%) of them were male. The numbers of children with isolated tracheomalacia, isolated bronchomalacia and tracheobronchomalacia were nine (13.8%), 48 (73.8%) and eight (12.3%), respectively. The most common reason for admission was recurrent and/or prolonged respiratory infection (46.2%) and the most common physical examination finding was stridor (36.9%). Fifty-eight (89.2%) patients had other co-morbidities associated with airway malacia. Inhaled ipratropium bromide therapy was started for 37 (56.9%) patients. Ten (15.4%) patients required continuous positive pressure support.. Conclusion: Lower airway malacia is an important disorder in children with respiratory problems and flexible bronchoscopy is a valuable diagnostic method. Sharing experiences in terms of diagnosis and treatment modalities would help patients as well as clinicians.

Background: Environmental tobacco smoke (ETS) exposure and sleep associated problems can lead to serious health problems in children. We aimed to evaluate association between ETS and sleep disturbance in children. Methods: We enrolled 209 children without chronic health problems or acute infections aged 4 to 12 years between June 2019 and March 2020 to this cross-sectional study. Parents’ smoking habits and ETS exposure of children were questioned and Children’s Sleep Habits Questionnaire (CSHQ) was administered to screen for the most common sleep problems in children. “Sleep disturbance” was defined as a score ≥41 in CSHQ. Plasma cotinine levels were measured in all subjects enrolled and levels ≥ 3 ng/mL were defined as ETS exposure. Results: Total 115 children (55 %) were in the “sleep disturbance” group according to CSHQ, and 66 (57.3%) of them were exposed to ETS according to parental report. The children with parent reported ETS exposure had increased risk of sleep disturbance (adjusted OR: 1.3). All 209 children had plasma cotinine levels ≥3 ng/ml, with a mean (SD) 50.55 (13.78) ng/ml, revealing that all of them were exposed to ETS although only 105 of them were parent reported. Multivariable analysis of risk factors for sleep disturbance revealed that parent reported ETS exposure was associated with increased risks of sleep disturbance (p=0.023, adjusted OR: 1.9 and 95%CI: 1.09-3.3) Conclusions: Parent reported ETS exposure is associated with sleep disturbance in their children however parental reports about smoking habits may not be compatible with plasma cotinine levels of the children.

Introduction: Pulmonary Thromboembolism (PTE) is a rare disease in children compared to adults. PTE in children often occurs in the presence of a risk factor or an underlying disease. Guidelines for diagnosis, treatment and follow-up in children with PTE are not available, and current practices have been taken from adult studies. Methods: The patients who were followed-up with the diagnosis of PTE between 2014-2019 in our hospital were retrospectively analyzed. Results: In the 6 years period, a total of 18 patients were diagnosed with PTE, and the median age of diagnosis was 15,7 years. Twelve (66.7%) were male. The average time from onset of symptoms to diagnosis was 3.7 days. After diagnosing PTE, 3 (16.6%) patients were diagnosed with Behcet9s Disease, 1 (5.5%) patient was infantile lupus and 1 (5.5%) patient was diagnosed with antiphospholipid syndrome. A clinical risk factor was present in 13 (72.2%) of the patients and 10 (5.5%) had a laboratory risk factor (Table-1). D-dimer was high in all patients and the diagnosis was confirmed by pulmonary computed tomography angiography. Pulmonary hypertension was determined in 4 (22.2%) patients. Tissue plasminogen activator was given to 5 (27.7%) of the patients. Four (22.2%) of the patients died due to other clinical reasons; 1 (5.5%) didn9t continue their follow-up; 8 (44.4%) of the patients had complete recovery; 4 (22.2%) of them were shown with pulmonary CTA that caused chronic changes. The mean follow-up time of the patients was 14.8 months (1-36 months). No recurrence was observed during the follow-up. Conclusions: PTE is encountered with many different etiologies in childhood so clinical suspicion should be kept high and risk factors should be well known.

Introduction: Bronchiectasis is characterized by irreversible regional or diffuse dilatation and structural disruption of bronchial tree with bronchial and peribronchial destruction; that is a chronic, progressive respiratory disease accompanied by persistent cough, sputum, and recurrent pulmonary infections. In developing countries, noncystic fibrosis bronchiectasis (NCFB) are more common than bronchiectasis with cystic fibrosis. In our study, we aimed to evaluate cases with NCFB in our clinic. Methods: Medical records of patients with NCFB those were admitted to our hospital between January 2014 and January 2020 were retrospectively analyzed. The demographic and clinical features, radiological findings and prognoses of the patients were evaluated. Results: Of total 40 patients the median age of diagnosis was 13 years. Twenty-four (60%) of the patients were girls. Immunodeficiencies (32.5%) were the most common etiological condition. Respiratory function tests were performed in 29 (72,5%) patients. The mean±SD values for FVC was 77±23%, FEV1 was 74±21%, FEV1/FVC was 95±12%, FEF25-75 was 78±30% at first evaluation. Haemophilus Influenza was the most commonly isolated microorganism from the sputum cultures. Twenty-seven (67,5%) patients underwent flexible bronchoscopy. Medical treatment was started in 29 (72.5%) of the patients. Three (7.5%) patients underwent lobectomy. The median follow-up period of the patients was 1 year 9 months. Conclusion: NCF bronchiectasis is an emerging pediatric disease. Early diagnosis is essential to prevent a progressive decline in lung function and recurring exacerbations. Etiology is essential to improve the course of the disease by using specific threapy.