Pediatric Flexible Bronchoscopy in Singapore A 10-year Experience

Aim: To determine the results of children who underwent flexible bronchoscopy and bronchoalveolar lavage (BAL) in the Respiratory Medicine Service of Kandang Kerbau Women's and Children's Hospital from 1996 to 2005. Method: This was a retrospective study of all patients who underwent flexible bronchoscopy. Patients were traced from the hospital records. Results: Two hundred and eight records were reviewed over a 10-year period. Of these, 63.5% were for male patients. The mean age of the patients was 4.1 years (range: 0.01 to 26 y). Sixty-six percent of the patients were below the age of 5 years. The main indications for bronchoscopy were abnormalities on chest x-ray (56.7%) followed by stridor (23.1%). An abnormality was detected in 77.7% of patients who underwent bronchoscopy. Twenty-three percent (n = 45) of the bronchoscopes with BAL were performed on immunocompromised children for identification of microorganisms, of which 20% (n = 9) yielded a positive microbiologic result. A positive yield was better if no earlier antimicrobials (26.3%) or only 1 antimicrobial was prescribed (42.8%) as compared with a 10% yield rate on treatment with 2 or more antimicrobials. The most common pathologic microorganisms identified were Candida albicans (18.5%) and Cytomegalovirus (18.5%). Complications from the bronchoscopy occurred in 16.6% of the patients. The main complication was hypoxia, which occurred in 28 children (13.4%). Other complications included cardiac arrhythmias (n = 1, 0.5%) and laryngospasm (n = 4, 1.9%). There were no fatalities experienced in our center. Conclusions: Flexible bronchoscopy was well tolerated with no serious adverse events being experienced. It is a useful tool in the investigation of stridor and persistent wheezing in children. For microbiologic identification, the BAL should be performed before initiating antimicrobials for better results.