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Updated: Jun 7, 2026
Systematic Bronchoscopy: the Four Landmarks Approach
Published on: June 23, 2023
Flexible bronchoscopy in young infants with hCoV-NL63-associated necrotizing laryngotracheobronchitis: findings and
Xiangzhi Xu1,2, Feizhou Zhang3,4,2, Lingfang Liang1,2
1Department of Pediatric Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China.
Background:
Human coronavirus NL63 (hCoV-NL63) is a major pathogen associated with pediatric acute respiratory tract infections. Although most infections are mild, severe lower airway complications have been increasingly reported. The aim of this study was to investigate the clinical and flexible bronchoscopy (FB) findings, as well as the interventional value, in young infants with hCoV-NL63-associated necrotizing laryngotracheobronchitis (NLTB).
Methods:
A retrospective case series was conducted at a tertiary pediatric intensive care unit between August 2025 and September 2025. Clinical data, including demographics, symptoms, imaging, FB findings, etiological test results, treatment strategies, and clinical outcomes of 3 young infants with confirmed hCoV‑NL63‑related NLTB were systematically analyzed.
Results:
All patients presented with progressive hoarseness, dyspnea, stridor, and upper airway obstruction as primary manifestations. FB demonstrated characteristic subglottic mucosal necrosis, ulceration, and airway stenosis in all cases. Urgent FB‑guided endotracheal intubation was successfully performed to secure the airway. Bronchoalveolar lavage fluid (BALF) examination confirmed hCoV‑NL63 infection, with concurrent Streptococcus pneumoniae detected in all samples. After comprehensive treatment including systemic glucocorticoids, broad‑spectrum antibiotics, airway management, and supportive care, all young infants showed significant clinical improvement, survived without serious complications, and were discharged successfully.
Conclusion:
hCoV-NL63 may be associated with severe NLTB in young infants. FB may play a valuable and important role in early diagnosis, airway evaluation, and guided intubation. Multimodal therapy achieves favorable short‑term outcomes. Clinicians should strengthen awareness of this rare but severe entity to avoid delayed diagnosis and inappropriate intervention. This study is hypothesis-generating only, and larger studies are needed to confirm these results.
Clinical Trial Number:
Not applicable.
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