Bronchological examinations in the Neonatal Intensive Care Unit

Abstract

We have been performing bronchoscopic examinations in our university since September 2002. To date 1220 bronchoscopic examinations in 883 children have been carried out, including 212 endoscopies in 186 newborns in the Neonatal Intensive Care Unit (NICU). Indications of bronchoscopies in NICU were difficulty in extubation, stridor, persistent atelectasis, localized hyperinflation, suspicion of tracheoesophageal fistula, presumed iatrogenic tracheal injury and intubation under fiberoptic bronchoscopy. In patients with extubation failure 3 patients with glottic-, 3 with subglottic-, and 2 with tracheal stenoses were treated conservatively and eventually successfully extubated, while three neonates with glottic stenosis needed tracheostomy tube placement and one newborn with subglottic stenosis was cured with cricoid split surgery. Bronchial stenosis was found in four cases of localized hyperinflation. In the stridor group 12 patients with soft larynx, 10 with glottic stenosis, 4 with subglottic stenosis, 3 with vocal cord paralysis and one with big tongue /Beckwith-Wiedemann syndrome/ did not require intervention. Two neonates with stridor had mucous pellicle in the glottis, which were bronchoscopically sucked. In six cases with stridor surgery was not avoidable including 3 tracheostomy tube placements, 2 cricoid split operations and one tracheal resection due to tracheal web. In the group of persistent atelectasis mucous plug was discovered and bronchoscopically removed in 5 cases, severe bronchial stenosis was confirmed in 4 children. We diagnosed two congenital tracheoesophageal fistulas and detected one tracheal rupture in a child with suspected tracheal injury.