Fiberoptic Bronchoscopy as a Diagnostic Tool in Neonatal Intensive Care Unit: A Single Center Experience

Document Type : Original Article

Authors

Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Respiratory disorders are recognized as a leading cause of morbidity and mortality in neonates. Fiberoptic Bronchoscopy (FOB) is used  by pediatricians both for diagnostic and therapeutic indications in children. Nonetheless, there is a paucity of data regarding the diagnostic utility and safety of FOB in neonates, and it has remained relatively under-used in the care of neonates. The present study provided a practical overview of the wide diagnostic aspects of the FOB in newborns hospitalized in the Neonatal Intensive Care Unit (NICU). Frequencies of common indications, their findings, and highlights contribute to the quick management of  neonates with respiratory disorders.
Methods: This descriptive study was conducted in the NICU of Namazi hospital and included 150 neonates with various respiratory problems admitted over 5 years within 2013-2018. All subjects underwent FOB and bronchoalveolar Lavage (BAL) using a bronchoscope of 2.8 (EVIS EXERA III Olympus bronchoscope).
Results: The greatest indications for performing FOB entailed hypersecretion in 138 (92%) cases, prolonged mechanical ventilation in 108 (72%) neonates, and persistent radiological finding in 97 (64.6%) subjects. Bronchoscopy detected various airways anomalies, such as Laryngomalacia (72%), Tracheobronchomalacia (64%), subglottic stenosis (26%), vocal cord paresis (18%), tracheoesophageal fistula (6.7%), laryngeal cleft (6%),  and laryngeal web (4%). BAL results demonstrated that the cultures were positive in 20 (13.33%) neonates. Acinetobacter was the most commonly reported bacterial infection observed in 8% of neonates.
Conclusion: As evidenced by the obtained results, when performed by an experienced and well-trained person and in an environment with appropriate facilities, FOB can be a safe and efficient tool for the early diagnosis of numerous airway disorders among neonates admitted to NICUs.
 
 

Keywords


  1. Qian LL, Liu CQ, Guo YX, Jiang YJ, Ni LM, Xia SW, L et al. Current status of neonatal acute respiratory disorders: A one-year prospective survey from a chinese neonatal network. Chin Med J (Engl). 2010; 123(20):2769-75.
  2. Pramanik AK, Rangaswamy N, Gates T. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am. 2015; 62(2):453-69.
  3. Liszewski MC, Stanescu AL, Phillips GS, Lee EY. Respiratory distress in neonates: Underlying causes and current imaging assessment. Radiol Clin North Am. 2017; 55(4):629-44.
  4. Tracy MK, Berkelhamer SK. Bronchopulmonary dysplasia and pulmonary outcomes of prematurity. Pediatr Ann. 2019; 48(4):e148-53.
  5. Chowdhury N, Giles BL, Dell SD. Full-term neonatal respiratory distress and chronic lung disease. Pediatr Ann. 2019; 48(4):e175-81.
  6. Seid SS, Ibro SA, Ahmed AA, Olani Akuma A, Reta EY, Haso TK, et al. Causes and factors associated with neonatal mortality in neonatal intensive care unit (nicu) of jimma university medical center, Jimma, South West Ethiopia. Pediatric Health Med Ther. 2019; 10:39-48.
  7. Vijayasekaran D, Kalpana S, Ramachandran P, Nedunchelian K. Indications and outcome of flexible bronchoscopy in neonates. Indian J Pediatr. 2012; 79(9):1181-4.
  8. Kohelet D, Arbel E, Shinwell ES. Flexible fiberoptic bronchoscopy--a bedside technique for neonato-logists. J Matern Fetal Neonatal Med. 2011; 24(3):531-5.
  9. Liu J, Ren XL, Fu W, Liu Y, Xia RM. Bronchoalveolar lavage for the treatment of neonatal pulmonary atelectasis under lung ultrasound monitoring. J Matern Fetal Neonatal Med. 2017; 30(19):2362-6.

10. Xu X, Liu XC, Li DD, Zhu B, Xiao LJ, Feng ZC, et
al. Diagnostic and therapeutic methods for perioperative children with congenital heart disease with airway stenosis in pediatric intensive care unit. Zhonghua Er Ke Za Zhi. 2013; 51(11):842-5.

11. Biban P, Rugolotto S, Zoppi G. Fiberoptic endotracheal intubation through an ultra-thin bronchoscope with suction channel in a newborn with difficult airway. Anesth Analg. 2000; 90(4):1007.

12. Perez-Ruiz E, Perez-Frias J, Martinez-Gonzalez B, Martinez-Aran T, Milano-Manso G, Martinez-Valverde A. Pediatric fiberoptic bronchoscopy. Analysis of a decade. An Esp Pediatr. 2001; 55(5):421-8.

13. Altin S, Dalar L, Karasulu L, Cetinkaya E, Timur S, Solmazer N. Resection of giant endobronchial hamartoma by electrocautery and cryotherapy via flexible bronchoscopy. Tuberk Toraks. 2007; 55(4):
390-4.

14. Mirzarahimi M, Barak M. Comparison efficacy of curosurf and survanta in preterm infants with respiratory distress syndrome. Pak J Pharm Sci. 2018; 31(2):469-72.

15. Sachdev A, Ghimiri A, Gupta N, Gupta D. Pre-decannulation flexible bronchoscopy in tracheo-stomized children. Pediatr Surg Int. 2017; 33(11):1195-200.

16. Cheng J, Cooper M, Tracy E. Clinical considerations for blunt laryngotracheal trauma in children. J Pediatr Surg. 2017; 52(5):874-80.

17. Placido-Paias R, Delgado-Pecellin I, Gonzalez-Valencia JP. Fiberoptic bronchoscopy findings in children with stridor in a tertiary hospital. Arch Bronconeumol. 2016; 52(6):335-6.

18. Nakano T, Shikada M, Nomura M, Kuwayama-Komaki F, Suganuma E, Ishikawa-Kato M, et al. Feasibility of fiberoptic bronchoscopy for small infants including newborns. Tokai J Exp Clin Med. 2004; 29(1):1-5.

19. Tang LF, Chen ZM. Fiberoptic bronchoscopy in neonatal and pediatric intensive care units: a 5-year experience. Med Princ Pract. 2009; 18(4):305-9.

20. Midulla F, de Blic J, Barbato A, Bush A, Eber E, Kotecha S, et al. Flexible endoscopy of paediatric airways. Eur Respir J. 2003; 22(4):698-708.

21. Foglia E, Meier MD, Elward A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev. 2007; 20(3):
409-25.

22. Tang LF, Chen ZM. Fiberoptic bronchoscopy in neonatal and pediatric intensive care units: a 5-year experience. Med Princ Pract. 2009; 18(4):305-9.