Efficacy and safety of bronchoalveolar lavage through flexible fiberoptic bronchoscope in treatment of neonatal atelectasis

Abstract

Objective To evaluate the clinical efficacy and safety of flexible fiberoptic bronchoscopy (FFB) and bronchoalveolar lavage (BAL) in treatment of neonatal atelectasis. Methods Eligible patients, who were diagnosed as neonatal pulmonary atelectasis and admitted consecutively to the neonatal intensive care unit of the Children's Hospital of Hebei Province from January 2013 to January 2015, were included in the study. They were randomly assigned to FFB group (n=30) and control group (n=28). Newborns in the FFB group received BAL under FFB, while those controls received tracheal irrigation after intubation. The duration of lung recruitment, oxygen exposure and antibiotic administration, hospital stay, culture results of respiratory secretions, prognosis and total expenses during hospitalization were compared between the two groups. Complications of FFB were also recorded.Chi-square test andt-test were performed for statistical analysis. Results (1) In the FFB group, atelectasis occurred in the upper right lobe (n=26), upper lobes of both sides (n=1), lower right lobe (n=2) and lower left lobe (n=1), while in the control group, atelectasis occurred in the upper right lobe (n=26), lower left lobe (n=1) and middle right lobe (n=2) (χ2=0.094,P>0.05). (2) The positive rate of bacteria culture results showed no difference between bronchoalveolar lavage fluid in FFB group and tracheal secretions in the controls [43%(13/30) vs 32%(9/28),χ2=0.770,P>0.05]. (3) The duration of lung recruitment, antibiotic administration and hospital stay of the FFB group were all shorter than those of the control group [(4.7±3.4) vs (7.4±6.6) d, (14.0±4.5) vs (20.3±10.9) d , (15.1±4.7) vs (21.8±12.3) d,t=5.718, 8.604 and 7.733, allP<0.05]. (4) Among babies in the FFB group, nine experienced fever and returned to normal after physical cooling; three showed more shadow in chest X-ray with aggravated dyspnea during a short period, and relieved 12 hours later; two had minimal hemorrhage from tracheal mucous membrane; one showed crying hoarse. Serious complications, such as pneumothorax, massive bleeding or cardiac arrest, did not occurred. No death or refuse of treatment was reported. Conclusion FFB and BAL is much more effective than tracheal irrigation after intubation in treatment of neonatal atelectasis without any severe complications. Key words: Pulmonary atelectasis; Bronchoscopy; Bronchoalveolar lavage; Infant, newborn