Fibrobroncoscopía en recién nacidos prematuros al momento de la extubación: Comunicación preliminar

Abstract

Routine post-extubation fiberoptic bronchoscopy (FOB) in neonates is aimed to promote early detection of acquired airway pathology eventually underdiagnosed by severe pulmonary disease. A one year prospective study was launched at the Neonatological Intensive Care Unit at San Borja Arriaran Clinical Hospital in August 2000, to evaluate safety and efficacy of FOB performed with trans-nasal anaesthesia and without sedation within 72 hours after extubation. Exclusion criteria were: body weight under 700 g, age under 7 days old, haemodynamic instability, intracraneal hemorrhage, FiO2 > 0,4 or known airway malformation. Fourteen neonates were evaluated. IPPV was used for a period ranging from 3 to 45 days (mean 14,4 days; being 43% over 10 days). Ten were males. Gestational age ranged from 26 to 36 weeks. (mean: 32 weeks); birthweight 900 to 3.000 g (50% < 1.500 g; 21% < 1.000 g). Intubation was due to Hyaline Membrane Disease in 10 patients (71%), to apnea in 2 and to pneumonia plus pulmonary hypertension in the other two. Seven patients had positive findings at FOB: 4 had congenital abnormalities: posterior laringomalacy (n = 2), laringomalacy plus coanal stenosis (1) and ring-shaped cricoides (1). Three patients had Acquired Subglottic Stenosis. Four kids required nasal CPAP, 2 intravenous dexametasone and 2 dilatations plus topic Mitomycin-C (> 70% subglottic area reduction). No patients had intercurrencies nor upper airway obstruction at discharge. Five developed Bronchopulmonary Displasia. In this study FOB post extubation was safe and efficient in pre-term neonates to ensure early diagnosis of airway pathology, even in asymptomatic patients; it allows to do effective treatments such as nasal CPAP, dilatations and anti-inflammatory drugs administration