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Safety and efficacy of flexible endoscopy in children with bronchopulmonary dysplasia
R C Cohn1, C Kercsmar, D Dearborn
1Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland.
Insights
Flexible fiberoptic bronchoscopy (FFB) is safe and effective for managing pediatric patients with bronchopulmonary dysplasia (BPD). This study shows FFB aids in diagnosis and treatment decisions for children with chronic lung conditions.
Area of Science:
- Pediatric Pulmonology
- Medical Procedures
- Respiratory Medicine
Background:
- Concerns exist regarding the safety and efficacy of flexible fiberoptic bronchoscopy (FFB) in pediatric patients with chronic cardiopulmonary disorders.
- Bronchopulmonary dysplasia (BPD) is a common chronic lung condition in infants, often associated with complex airway issues.
Purpose of the Study:
- To evaluate the safety and utility of FFB in managing pediatric patients with a history of BPD.
- To analyze indications, findings, complications, and impact on management from FFB procedures in this population.
Main Methods:
- Retrospective review of 129 FFB procedures performed on 47 children with BPD over 44 months.
- Analysis of indications, patient demographics, procedural details, endoscopic findings, specimen results, and complications.
Main Results:
- The most common indications were subglottic stenosis (33%) and airway abnormalities (32%).
- Diverse endoscopic diagnoses were identified, including adenoidal hypertrophy, laryngomalacia, and tracheobronchomalacia.
- Minor complications occurred in 3.1% of procedures, with no severe events. Management was directly influenced by FFB results in 41% of cases.
Conclusions:
- Flexible fiberoptic bronchoscopy is a safe and valuable tool for the diagnosis and management of children with bronchopulmonary dysplasia.
- FFB provides crucial information that directly impacts clinical decision-making in pediatric patients with chronic respiratory conditions.
Abstract:
Because concern has been raised about the efficacy and safety of flexible fiberoptic bronchoscopy (FFB) in pediatric patients with chronic cardiopulmonary disorders, we reviewed the results of 129 flexible endoscopies performed on 47 children with a history of bronchopulmonary dysplasia (BPD) at our institution over a 44-month period. Indications for FFB; weight and age of the patient; and procedure format, including medication usage, findings, specimen results, and complications, were analyzed. Evaluation of previously diagnosed subglottic stenosis and airway abnormalities were the two most common indications (33% and 32%, respectively). Persistent or recurrent infiltrates or atelectasis, need for cultures, stridor, failure to extubate, hoarseness, and persistent wheeze were also cited. Endoscopic diagnoses included adenoidal hypertrophy, laryngomalacia, vocal cord abnormalities, interarytenoid membrane, subglottic stenosis, granulomas, tracheobronchomalacia, stenosis, obstruction, generalized inflammation/edema, polyps, tracheal bronchi, and anomalous bronchial anatomy. Cytomegalovirus, pneumococcus, nontypeable Haemophilus influenzae, Pseudomonas, or mixed gram-negative flora were isolated from some patients without tracheostomy. Minor complications (transient bradycardia, mild nasopharyngeal bleeding, and mild worsening of upper airway obstruction) occurred in 3.1% of procedures, but no severe complications occurred. Management was directly affected by procedure results in 41% of procedures. We concluded that the FFB can be a safe, useful procedure in the management of children with BPD.