Fiberoptic Bronchoscopy as a Diagnostic Tool in NICU: A Single Center Experience

Abstract

Objective: Respiratory disorders are an important cause of morbidity and mortality in neonates. Fiberoptic Bronchoscopy (FOB) is being increasingly used by pediatricians both for diagnostic and therapeutic indications in children. However, information on diagnostic utility and safety of FOB in neonates is limited. FOB remains relatively under-used in the care of neonates. This article provides a practical overview of the wide diagnostic aspects of the FOB in infants who are hospitalized in Neonatal Intensive Care Unit (NICU). Frequencies of common indications, their findings, and highlights contribute to quick managing of those neonates with respiratory disorders.Patients and Methods: This descriptive study was conducted in the NICU of Namazi hospital and included 150 neonates with various respiratory problems admitted over a 5-year period, from 2013 till 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 doing FOB were hyper Secretion in 138 (92%), prolonged mechanical ventilation in 108 (72%) and persistent radiological finding in 97 (64.6%). 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 showed that the cultures were positive in 13.33% (20) of neonates. Acinetobacter was the most commonly reported bacterial infection, observed in 8% of neonates.Conclusions: Findings of this study demonstrate that FOB, when performed by an experienced and well-trained person and in an environment with appropriate facilities, can be a safe and useful tool for the early diagnosis of many of the airway disorders among neonates who are admitted in NICUs.