Fiberoptic bronchoscopy in the treatment of intubated neonates

E. S. Shinwell, R. D. Higgins, R. L. Auten and D. L. Shapiro
Department of Pediatrics (Neonatology), University of Rochester, School of Medicine, NY.

A study of the role of fiberoptic bronchoscopy in intubated neonates was conducted. The study aimed to ascertain the applicability of fiberoptic bronchoscopy for assessment of endotracheal tube tip position, and to assess the incidence and clinical significance of airway disease in unselected patients. Seventy examinations on 65 neonates were performed without interruption of mechanical ventilation. The procedure was well tolerated in all cases. The accuracy of bronchoscopic measurement of endotracheal tube tip position improved markedly with user experience and reached a correlation of .96 with a chest roentgenogram. Although the technique was safe and accurate, the need for available and skilled personnel may limit the applicability of this method for endotracheal tube tip position assessment. Significant airway disease requiring a change in treatment was found in 13 patients (19%). This high incidence of significant but clinically unsuspected airway disease suggests that there should be more frequent consideration of diagnostic bronchoscopy in all sick intubated neonates who are at risk for airway disease.