Congenital Airway Anomalies in Children: A Decade of Evidence on Pulmonologic Challenges, Surgical Management, and Speech Rehabilitation — A Systematic Review and Pooled Cohort Analysis of Published Data (2015–2024)
Keywords:
Congenital airway anomaly, tracheal stenosis, pediatric airway surgery, pulmonology, speech rehabilitation, systematic reviewAbstract
Background: Congenital airway anomalies (CAA) are rare but serious structural malformations of the upper and lower airways in children, frequently presenting with respiratory distress, feeding difficulties, and impaired speech development. The past decade has witnessed major advances in diagnosis, surgical correction, and multidisciplinary rehabilitation, yet global outcome data remain fragmented.
Objective: To systematically review literature published between 2015 and 2024 on congenital airway anomalies in children, evaluating pulmonologic outcomes, surgical management strategies, and speech/voice rehabilitation, and to perform a pooled cohort analysis of reported outcomes.
Methods: Following PRISMA 2020 guidelines, PubMed, Embase, Web of Science, and the Cochrane Library were searched for eligible studies (2015–2024). Inclusion criteria were cohort studies, case series ≥ 10 patients, or interventional trials involving children (0–18 years) with congenital airway anomalies. Data were extracted on study design, sample size, anomaly type, intervention, and outcomes. Pooled analysis of proportions was performed using a random-effects model.
Results: Thirty-four studies met inclusion criteria, encompassing 2,986 children with congenital airway anomalies (upper airway = 38 %, tracheal = 44 %, bronchial/vascular compression = 18 %). The pooled decannulation rate following reconstructive surgery was 82 % (95 % CI 78–86 %). Major postoperative complications occurred in 16 % (95 % CI 12–19 %), while mortality was 4.1 % (95 % CI 2.7–5.9 %). Among 12 studies reporting speech outcomes, 73 % of children achieved functional voice intelligibility after structured speech therapy within 18 months post-surgery. Early surgical correction (< 1 year of age) correlated with superior pulmonary recovery and shorter rehabilitation time. Heterogeneity among speech outcome measures limited meta-analysis.
Conclusion: Over the last decade, surgical outcomes for congenital airway anomalies have markedly improved, with high survival and airway patency rates. However, standardized reporting of speech and long-term pulmonary outcomes is lacking. Future multicentre registries integrating pulmonologic, surgical, and rehabilitative data are essential to guide holistic care
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