NECNATAL ATELECTASIS AND/OR EMPHYSEMA: VALUE OF FLEXIBLE BRONCHOSCOPY

Abstract

Occurence of atelectasis and/or emphysema is common in neonatal intensive care units and sets both diagnostic and therapeutic problems. During the last three years we performed flexible bronchoscopy (FB) in 50 neonates and premature infants (mean weight 2050 gr, range 950-4050 gr). Fourty four were intubated before examination. FB was performed under EKG and TcPO2 monitoring. We used a three way stopcock connected to both mechanical ventilation and aspiration source. This procedure allowed alternative adequate ventilation or suctioning. Ten newborns had acute postextubation or post-surgical atelectasis, affecting particularly right upper lobe. No important anatomic lesion was discovered, yet suctioning was effective in 7 cases (70 %). Fourty had persistent atelectasis and/or emphysema and were long term intubated. Endoscopic abnomalities were frequent : 2 mucopurulent plugs, 4 important tracheobronchial dyskinesia, 13 severe local inflammatory injuries narrowing one or more lobar opening, 5 lower tracheal stenosis (1 congenital and 4 acquired) and 6 bronchial stenosis (4 troncus intermedius and 2 left main stem bronchus). Only 10 FB were normal. Suctioning was effective in only 11 cases (22 %). These results confirm interest of FB in neonates and premature infants to remove an acute atelectasis and to explore a persistent atelectasis and/or emphysema. FB allows thus to emphasize the role of inflammatory injuries due to iterative suctioning and the risk of tracheal or bronchial stenosis (27 %).

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