Pediatric Flexible Bronchoscopy in Singapore: A 10-year Experience

To determine the results of children who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) in the Respiratory Medicine Service of Kandang Kerbau Women's and Children's Hospital from 1996 to 2005.

This was a retrospective study of all patients who underwent flexible bronchoscopy. Patients were traced from the hospital records.

Two hundred and eight records were reviewed over a 10-year period. Of these, 63.5% were for male patients. The mean age of the patients was 4.1 years (range: 0.01 to 26 y). Sixty-six percent of the patients were below the age of 5 years. The main indications for bronchoscopy were abnormalities on chest x-ray (56.7%) followed by stridor (23.1%). An abnormality was detected in 77.7% of patients who underwent bronchoscopy. Twenty-three percent (n=45) of the bronchoscopes with BAL were performed on immunocompromised children for identification of microorganisms, of which 20% (n=9) yielded a positive microbiologic result. A positive yield was better if no earlier antimicrobials (26.3%) or only 1 antimicrobial was prescribed (42.8%) as compared with a 10% yield rate on treatment with 2 or more antimicrobials. The most common pathologic microorganisms identified were Candida albicans (18.5%) and Cytomegalovirus (18.5%). Complications from the bronchoscopy occurred in 16.6% of the patients. The main complication was hypoxia, which occurred in 28 children (13.4%). Other complications included cardiac arrhythmias (n=1, 0.5%) and laryngospasm (n=4, 1.9%). There were no fatalities experienced in our center.

Flexible bronchoscopy was well tolerated with no serious adverse events being experienced. It is a useful tool in the investigation of stridor and persistent wheezing in children. For microbiologic identification, the BAL should be performed before initiating antimicrobials for better results.