Bronchoscopy in the newborn

Bronchoscopy in the newborn is an important diagnostic and

therapeutic tool.1 Diagnosis of congenital laryngotracheal

malformations and management of airway complications

secondary to prolonged intubation are the two most

common indications for pediatric bronchoscopy.2 Broncho-

scopy in children was first performed by Killian in 1895.3 It

was, however, associated with a high rate of complications

due to poor visibility through small-diameter bronchoscopes,

lack of a satisfactory light source, and difficulty maintaining

ventilation during the procedure. Modern Hopkins lens

systems’ intense yet ‘cold’ light sources together with modern

anesthetic techniques have facilitated safer examination of the

airway in the newborn.4,5 Pediatric flexible bronchoscopy was

initiated in the mid 1970s, after Ikeda introduced the flexible

bronchofibersope in 1968. Since then newer and smaller

instrumentation and the addition of suction channels have

enabled the bronchoscopist to examine the airway without

significantly distorting the anatomy or the normal physiology

and has largely superseded rigid bronchoscopy for diagnostic

purposes in the lower airway.6 The development of the

pediatric fiberoptic nasendoscope, while not permitting a

view of the trachea or bronchi, has dramatically changed

airway endoscopy in the newborn. Infants, with stridor who

are otherwise well, can have their larynx and upper airways

examined at the bedside or the outpatient clinic. If a

diagnosis of laryngomalacia is made, laryngoscopy and

bronchoscopy under general anesthesia may not be required.

However, the airway control and therapeutic ability of rigid

bronchoscopy have not been replaced and it remains an

important and potentially life-saving procedure.