Bedside flexible bronchoscopy in the neonatal intensive care unit: Current evidence, clinical applications and future directions.

BACKGROUND

Lung ultrasound and targeted echocardiography let the neonatal team examine lungs and heart at the cot side, but neither shows the airway. Flexible bronchoscopy does, and it is increasingly performed inside the neonatal intensive care unit (NICU).

METHODS

Narrative review of published series of flexible bronchoscopy in infants cared for in neonatal units, supported by pediatric intensive care studies and society standards. Certainty of evidence was not graded.

RESULTS

Twelve neonatal series (652 infants) were identified; all but one were single-center and most were retrospective. In referred infants, airway abnormalities were reported in 60-96% and a change in management in 63-94%; when intubated neonates were examined routinely, significant airway disease was found in 19%. The main indications were repeated extubation failure, persistent atelectasis, stridor and suspected congenital anomaly. Transient desaturation occurred in 2-24% of procedures, and one bilateral pneumothorax was reported. Where identified, the operator was usually a pediatric pulmonologist, so the procedure is currently a bedside consultation, not point-of-care testing in the sense applied to ultrasound. No study has examined mortality, bronchopulmonary dysplasia, duration of ventilation or length of stay.

CONCLUSIONS

Bedside flexible bronchoscopy answers questions about the neonatal airway that ultrasound cannot, and in selected infants it often changes what is done next. Its place should be defined by prospective studies with stated denominators, consistent reporting of physiological cost, and a training pathway for neonatal operators. Reduced exposure to tuberculosis and other hospital pathogens by avoiding transport is a hypothesis, not a demonstrated benefit.