THREE babies suffering from an airway condition that presented little chance of them reaching young childhood have had their lives saved by the innovative use of 3D-printed, growth-flexible implants.
Paediatric tracheobronchomalacia (TBM) is a rare congenital condition that affects approximately 1 in 2,200 births. Often misdiagnosed as treatment-resistant asthma, TBM sees an excessive collapse of the airways during breathing that can lead to life-threatening cardiopulmonary arrests, and though most children outgrow mild cases by the ages of 2-3 years, severe cases where the child is at impending risk of death require aggressive treatment.
Until recently, available conventional therapies used to treat the condition have carried their own life-threatening complications. Babies required tracheostomy tube placement with mechanical ventilation, causing prolonged hospitalisation and dangerous complications; for example, the rate of respiratory arrest due to tube occlusion is as high as 43% of annual paediatric tracheostomy procedures. Yet thanks to researchers at the University of Michigan’s C.S. Mitt Children’s Hospital, Ann Arbor, Michigan, USA, newly developed 3D-printed devices, which stent the airways in such a way as to allow the supports to grow as the child does, have been used to treat three boys aged 3 months, 5 months, and 16 months. “If a child can be supported through the first 24-36 months of TBM, airway growth generally results in natural resolution of this disease,” wrote the authors.
The 3D-printed splints were designed to be customisable to the individual patient’s anatomy, regarding the inner diameter, length, and wall thickness of the device, and the number and spacing of suture holes. All inserts placed around the airways were made of polycaprolactone, which harmlessly dissolves in the body at a rate to allow the device time to support growing cartilage. This accommodates airway growth, simultaneously preventing external compression over a period of time before bioresorption, allowing for radial expansion of the airway during the critical period of growth.
Dr Glenn Green, Associate Professor, Paediatric Otolaryngology, C.S. Mott Children’s Hospital, said: “The device worked better than we could have ever imagined. We have been able to successfully replicate this procedure and have been watching patients closely to see whether the device is doing what it was intended to do. We found that this treatment continues to prove to be a promising option for children facing this life-threatening condition that has no cure.” More data is required before this procedure may be implemented in medical practice.