Safety and efficacy of flexible endoscopy in children with bronchopulmonary dysplasia
R. C. Cohn, C. Kercsmar and D. Dearborn
Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland.
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.
