Flexible bronchoscopic findings in children with recurrent croup: a retrospective study from Alexandria university children’s hospital

Abstract Background Recurrent croup in children poses a diagnostic challenge, often indicating underlying anatomical or functional airway abnormalities beyond typical viral etiology. Flexible bronchoscopy offers valuable insight into such abnormalities, yet its utility in evaluating recurrent croup remains underexplored in the Egyptian pediatric population. Methods This retrospective study reviewed the medical records of children presenting with recurrent croup who underwent flexible bronchoscopy at the Pediatric Bronchoscopy Unit, Smouha University Children’s Hospital, Alexandria, from January 2013 to February 2024. Recurrent croup was defined as two or more episodes per year. Demographic, clinical, and bronchoscopic data were extracted and analyzed. Descriptive statistics summarized patient characteristics, while Pearson correlation coefficients assessed associations between historical variables and bronchoscopic findings. Results A total of 92 children (43% female) were included, with a median age of approximately 4 years. The majority were infants and toddlers (39%). Bronchoscopic abnormalities were identified in 86% of cases, with hyperemic mucosa being the most prevalent finding (40%). Laryngomalacia and excessive dynamic airway collapse were each observed in 16%, while tracheomalacia, bronchomalacia, and suspected gastroesophageal reflux disease (GERD) were noted in 12%, 9%, and 15% of patients, respectively. Structural abnormalities included subglottic stenosis (7%), laryngeal cleft (11%), tracheal stenosis (3%), and external vascular compression (9%). Statistically significant correlations were found between younger age and subglottic stenosis (r = -0.239, p = 0.022), recurrent infections and tracheal stenosis (r = 0.250, p = 0.016), and prior hospitalizations with both subglottic stenosis (r = 0.256, p = 0.014) and laryngeal cleft (r = 0.338, p = 0.001). Conclusions Recurrent croup in children is frequently associated with underlying airway abnormalities detectable by flexible bronchoscopy. Inflammatory and dynamic airway changes are common, while a significant proportion also exhibit structural defects requiring further evaluation or intervention. These findings support the early use of flexible bronchoscopy in children with recurrent croup to enable accurate diagnosis and guide clinical management.