The Value of Flexible Bronchoscopy in the Neonatal Intensive Care Unit

Abstract

Objective: Flexible bronchoscopy (FB) is a safe and valuable tool for the assessment and treatment of patients in neonatal intensive care units (NICUs) with respiratory diseases. Methods: All neonates who underwent FB in the NICU between July 2014 and July 2020 were included in the study. All demographic and clinical data including FB indications, the FB procedure performed and FB findings, FB complications, and the contribution of FB to the management were examined. Results: Forty-eight patients underwent FB. Twenty-two (45.8%) of them were male. The median age was 44 days (26.2–59.7). The most common indication for FB was extubation failure at 50%, followed by suspected airway disease at 33%. Bronchoscopic assessments revealed at least one abnormality in 46 (95.8%) infants. Bronchoalveolar lavage (BAL) was performed in 41 (85.4%) patients. FB contributed to the management in 46 (93.8%) of the patients. Based on FB results, 16 of 48 (33.3%) patients received a diagnosis by bronchoscopy, and medical treatments were revised in 23 (48%) patients. A successful therapeutic lavage was made in 7 (14.6%) of patients. Surgical interventions were performed in 28 (58.3%) of the patients. Conclusion: FB has an important value in the diagnosis and management of respiratory disorders in NICU. Direct visualization of the airways, microbiological assessment of BAL, and removal of mucus plugs allow the clinicians to make an accurate diagnosis and provide appropriate treatment options, including airway surgical procedures.