Utility of flexible fibreoptic bronchoscopy in Neonatal intensive Care Unit

Abstract

Introduction: Fiberoptic flexible bronchoscopy (FFB) in neonatal intensive care units (NICU) is useful for diagnosis and guiding therapeutic interventions. Aim: To evaluate the utility of FFB for the diagnosis and interventions based on its findings. Methods and Materials: A retrospective, medical chart search was conducted in neonates who underwent FFB over a period of 7 years. Besides demographic data and FFB diagnostic findings, the results of medical and/or surgical interventions done by treating neonatologist were recorded. Results: Total 88 bronchoscopies were performed in 83 neonates of which, 37 bronchoscopies were done through endotracheal tube. Indications included persistent need for mechanical ventilation (32/88) persistent atelectasis (21/88), stridor (27/88), extubation failure (4/88), recurrent apnea (2/88) and suspected airway anomaly (2/88). Airway anomalies diagnosed by FFB were tracheobronchomalacia (20/88), laryngomalacia (18/88), subglottic stenosis(7/88), choanal atresia (4/88), laryngeal cleft (4/88), tracheoesophageal fistula (TEF) (4/88), one each of pyriform stenosis, laryngeal web, vocal cord paresis, absent and complete tracheal rings. Radiological improvement after FFB was seen in 43.1% cases. Surgical interventions were undertaken in 17 cases, including 9 tracheostomies and 2 slide tracheoplasties. Conclusion: FFB can be useful for early diagnosis of congenital airway anomalies allowing early intervention for the same.