Leyens Judith, Schroeder Lukas, Salatsch Carmen, Schmitt Joachim, Sabir Hemmen, Mueller Andreas, Kipfmueller Florian, Dresbach Till
Department of Neonatology and Pediatric Intensive Care, University Hospital of Bonn, Bonn, Germany.
Division of Neonatology, Department of Pediatrics, BC Women's and Children's Hospital, University of British Columbia, Vancouver, Canada.
Pediatr Pulmonol. 2025 May;60(5):e71128. doi: 10.1002/ppul.71128.
Flexible bronchoscopy (FB) may facilitate ECMO and ventilator weaning through diagnosing airway anomalies and removal of mucous plugs in the critically-ill pediatric population. Only few studies on FB in critically-ill neonates exist, and even fewer focus on neonates with congenital diaphragmatic hernia (CDH) requiring extracorporal membrane oxygenation (ECMO). This study aims to evaluate the risk and benefit of FB in infants with CDH.
A retrospective review of CDH infants treated at a specialized single center between October 2019 and August 2024 was conducted. Baseline characteristics were compared between patients with and without FB. Procedural indications, findings and complications were analyzed.
A total of 142 newborns were analyzed. Infants requiring FB (n = 29, 20.4%) exhibited an overall higher disease burden (lower observed-to-expected lung-to-head ratio [p < 0.001), liver herniation (p = 0.002), ECMO (p < 0.001), defect size (p = 0.042), congenital anomalies (p = 0.019), heart defects (p = 0.010)]. The primary indications for the total 56 FBs were prolonged weaning and pulmonary hemorrhage. The most common complication was self-resolved hypoxemia (16.1%). Bronchial casts were found in 31.6%. Tracheo-/bronchomalacia was diagnosed in 16 infants (55.2%). Postprocedural chest Xrays were mostly unchanged (61.9%). A trend to achieve higher tidal volumes post-FB (p = 0.090) with similar peak inspiratory pressures (p = 0.917) was noted.
In critically-ill neonates with CDH, FB was safe, with a high diagnostic and potential therapeutic yield. The necessity for FB may be an additional indicator of CDH disease severity. Further research is needed to establish uniform assessment metrics and explore other modalities such as electrical impedance tomography or lung ultrasound in the context of FB.
在危重症儿科患者中，可弯曲支气管镜检查（FB）有助于体外膜肺氧合（ECMO）和呼吸机撤机，通过诊断气道异常和清除黏液栓来实现。关于危重症新生儿的FB研究很少，而关注需要体外膜肺氧合（ECMO）的先天性膈疝（CDH）新生儿的研究更少。本研究旨在评估FB用于CDH婴儿的风险和益处。
对2019年10月至2024年8月在一家专业单中心接受治疗的CDH婴儿进行回顾性研究。比较接受和未接受FB治疗的患者的基线特征。分析操作指征、检查结果和并发症。
共分析了142例新生儿。需要FB的婴儿（n = 29，20.4%）总体疾病负担更高（观察到的肺头比与预期相比更低[p < 0.001]）、肝脏疝出（p = 0.002）、ECMO（p < 0.001）、缺损大小（p = 0.042）、先天性异常（p = 0.019）、心脏缺陷（p = 0.010）。总共56次FB的主要指征是撤机时间延长和肺出血。最常见的并发症是自行缓解的低氧血症（16.1%）。发现支气管铸型的比例为31.6%。16例婴儿（55.2%）被诊断为气管/支气管软化。术后胸部X光大多无变化（61.9%）。注意到FB后潮气量有增加趋势（p = 0.090），而吸气峰压相似（p = 0.917）。
在患有CDH的危重症新生儿中，FB是安全的，具有较高的诊断价值和潜在治疗效果。FB的必要性可能是CDH疾病严重程度的一个额外指标。需要进一步研究以建立统一的评估指标，并在FB背景下探索其他模式，如电阻抗断层扫描或肺部超声。
