Neonatal/infant rigid bronchoscopy

The neonatal intensive care unit (NICU) of the Montreal Children's Hospital (MCH) has averaged 358 admissions/ year over the past 10 years. Over the same period, 1.8% of these admissions have required rigid bronchoscopy in either the neonatal or infant time period: 175 rigid bronchoscopies were performed on 76 patients since 1977.

We retrospectively reviewed the findings at first bronchoscopy. Our cases were analyzed regarding indication for bronchoscopy, primary airway pathology, concomitant secondary airway pathology, management, outcome, and overall prognosis.

Normal bronchoscopic findings were seen in 25% of cases. The remaining 75% revealed pathology in sites ranging from the oropharynx to the bronchus. The majority were subglottic (15), esophageal atresia/tracheoesophageal fistula (14), and glottic (11). There was concurrent airway pathology in 41% of the cases, ranging from 0% in the bronchial group to 75% in the oral/pharyngeal group. Thirty three percent of patients with a secondary airway pathology identified required further airway intervention, either therapeutic bronchoscopy at the same time or later airway surgery. There were no major complications from rigid bronchoscopy in our series. The mortality due to airway pathology was highest in the supraglottic/ glottic group (36%).

Rigid bronchoscopy performed in the neonatal/infant period is safe. The primary and concomitant secondary diagnosis are high (75% and 41%, respectively), while both may require further airway intervention. Finally, it directs early management of these cases for better prognosis.