The effect of bethanechol on tracheobronchomalacia in preterm infants with bronchopulmonary dysplasia: a retrospective cohort study

Objective Bethanechol has demonstrated improvement in trachealis tone in animal models, but no trials have studied efficacy in infants. This study aimed to examine if bethanechol improves a standardized pulmonary severity score (PSS) in infants with severe bronchopulmonary dysplasia with a diagnosis of tracheobronchomalacia (TBM). Study design This retrospective cohort study evaluated cases treated with bethanechol matched with controls who did not receive bethanechol. TBM was diagnosed by dynamic computography. Daily PSS was recorded for each infant from 40 to 55 weeks post-menstrual age. Results Cases’ mean PSS change was 21% lower than the controls’ mean PSS change pre- and post-bethanechol (95% CI −40%, −2%) by paired t -test ( p = 0.03). Matched differences (controls’ PSS – cases’ PSS) demonstrated greater mean PSS difference post-bethanechol compared to pre-bethanechol 0.17, (95% CI 0.05, 0.29) by paired t -test ( p = 0.009). Conclusion Infants with TBM treated with bethanechol compared to those not treated had a lower PSS reflecting improved respiratory status.