Flexible fiberoptic bronchoscopy - A bedside technique for neonatologists

Background. Flexible fiberoptic bronchoscopy (FFB) is an under-used technology in neonates, mostly performed by external consultants from either pulmonology or otolaryngology. Modern ultra-thin scopes offer the neonatologist new diagnostic and therapeutic opportunities at the bedside. Objective. To describe the diagnostic value, therapeutic potential, and safety profile of FFB in neonates when performed by neonatologists as a bedside procedure. Methods. This was a retrospective case series that included 19 term and preterm infants who underwent FFB in two Neonatal Intensive Care Units (NICU). Results. Twenty-five procedures were performed for the following indications: suspected airway pathology (15); BAL (8), noisy breathing (4), aid to difficult endotracheal intubation (1), investigation for failure of weaning from ventilation (6), and evaluation of tracheotomy or endotracheal tube patency (5). Thirteen procedures had more than one indication. Airway pathology was observed in 15 of 25 (60%) procedures. Treatment of atelectasis was successful in 7 of 10 cases. BAL culture results influenced antibiotic therapy in 5 of 10 cases (50%). No procedure-related mortality occurred. One serious adverse event (1/25, 4%), namely bilateral pneumothorax occurred 1 h after FFB. Conclusions. FFB is a useful and safe procedure that belongs in the neonatologists' armamentarium.