Bronchoalveolar lavage in ventilated newborn infants: safety and tumor necrosis factor-alpha activity

To investigate the safety of bronchoalveolar lavage (BAL) in sick ventilated preterm and term newborn infants.

We studied 32 preterm and term newborn infants on mechanical ventilation during the first week of life. BAL was done through blind wedging of a suction catheter into the right lower lobe bronchus, and lavages were tested for albumin content and tumor necrosis factor-alpha (TNF-alpha) activity. Safety measures included cranial ultrasounds, chest radiographs, arterial pH and blood gas monitoring, and checking ventilatory settings before and up to 24 hours after the procedure and heart rate, oxygen saturation level and arterial blood pressure before, during and within 10 minutes after the procedure.

Heart rate dropped an average of 15% (p < 0.001), oxygen saturation decreased by 4% (p = 0.001), and systolic blood pressure increased by 19% (p < 0.001) during BAL, but these measures returned to baseline on completion of the procedure and were not outside of a physiologically accepted range. BAL did not result in neonatal morbidity or mortality. Blood pressure perturbations were of a lesser magnitude in infants with a birth weight < 1000 gm than in those > 1000 gm. The lavage fluid contained albumin, and TNF-alpha titers were generally low except in two very preterm infants with extensive intracranial hemorrhages and one preterm infant with sepsis from chorioamnionitis.

BAL can be safely performed in intubated preterm and term infants, and the lavage samples are useful for cytokine assays.