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Introduction: Lower airway malacia (LAM) is characterized by a reduction in the cross-sectional luminal area during quiet respiration. There is no gold standard diagnostic test; however, flexible fiberoptic bronchoscopy (FFB) is most frequently utilized. The exact prevalence and incidence of LAM are unknown. This study aimed to determine the prevalence rates of pediatric patients diagnosed with LAM, offer a detailed understanding of their demographic and clinical characteristics, and investigate distinctions between two specific types of LAM, namely, tracheomalacia (TM) and bronchomalacia (BM). Materials and Methods: Patients younger than 18 years diagnosed with LAM using FFB were included in this retrospective case series. Demographic and clinical characteristics and comorbid disorders were compared between patients with isolated BM and those with isolated TM or tracheobronchomalacia (TM/TBM). Results: Among 390 patients who underwent FFB, 65 (16.6%) were diagnosed with LAM, 16 (24.6%) with TM, and 56 (86.2%) with BM. The median age at diagnosis was 15 months. Among them, 59 (90.8%) had other comorbidities; gastrointestinal (GI) disorders were the most common (38.5%). The most common indications for bronchoscopy were recurrent/prolonged lower respiratory tract infections (LRTI) or wheezing (43.1%), while the most frequently observed respiratory physical examination finding was stridor (35.4%). Patients with TM/TBM had significantly higher frequencies of premature births, stridor, retraction, and GI disorders. Conclusion: Patients with stridor without typical laryngomalacia features or recurrent or prolonged LRTI should undergo prompt evaluation for LAM. The potential coexistence of GI disorders such as gastroesophageal reflux disease and swallowing dysfunction should also be considered. [ABSTRACT FROM AUTHOR]

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Aim: As the application of flexible bronchoscopy (FB) has a high risk for infection transmission, it is recommended to postpone elective FB procedures during the coronavirus disease-2019 (COVID-19) pandemic. We aimed to determine how the COVID-19 pandemic affected pediatric FB implementation. Materials and Methods: Medical records of patients who underwent FB from March 11, 2015, to September 11, 2020, were examined retrospectively. Records of the post-COVID-19 period (March 11, 2020, to September 11, 2020) were compared with records of pre-COVID-19 (consists of each six-month time window from March 11 to September 11 of each year from 2015 to 2019) period in terms of hospitalization status of the patients, with numbers and indications of FB. Some additional measures were taken during the FB procedure in the post-COVID-19 period. A number of health workers infected during FB procedures in the post-COVID-19 period were reviewed. Results: Of the total of 182 procedures, the least FB was performed in the post-COVID-19 period (34, 30, 36, 36, 25, and 21 procedures respectively from 2015 to 2020). While microbiological sampling with bronchoalveolar lavage was the most common indication in the post-COVID-19 period, atelectasis was leading in the pre-COVID-19 period (p<0.001). In the post-COVID-19 period, most of the patients were inpatients while outpatient predominance was determined in the pre-COVID-19 period (p<0.001). None of the health workers was infected during the FB procedure. Conclusion: Postponing elective FB procedures decreased the numbers and affected the indications of procedures during the COVID-19 era. Taking additional measures is of great importance and effective to prevent transmission of infection during FB. [ABSTRACT FROM AUTHOR]