Serial bronchoalveolar lavage of preterm infants is not associated with chest radiological changes

Abstract.

Concern has been raised that serial non-bronchoscopic bronchoalveolar lavage (NB-BAL) may constantly remove surfactant which may result in localised radiological changes. Radiological scores for the lavaged right lower lobe (RLL) were compared with (1) the scores for the unlavaged contra-lateral left lower lobe (LLL) in the NB-BAL group and (2) with the scores of the RLL of control infants not undergoing any formal lavage procedure. NB-BAL was performed daily for 2 weeks and twice weekly thereafter until 28 days of age or until extubation. Two paediatric radiologists obtained chest radiological scores at 1 (pre-lavage radiograph), 7 and 28 days of age. A total of 28 infants in the NB-BAL group (mean birth weight 1350 g and gestation 28.6 weeks) and 26 control infants (1450 g, 29.9 weeks) were studied. Radiological scores for the lavaged RLL and the unlavaged LLL in the NB-BAL group were similar at all time points studied. Although the RLL score in the NB-BAL group was higher on day 1 prior to NB-BAL when compared to control infants (3.2 versus 2.5, P<0.05), the subsequent scores at day 7 (2.6 versus 2.9) and 28 (2.7 versus 2.8) were similar in both groups. No differences were found between the two groups for any clinical parameter including ventilation, oxygen dependency, retinopathy of prematurity or intracranial haemorrhage. Conclusion: repeated non-bronchoscopic bronchoalveolar lavage in newborn infants does not appear to be associated with radiological changes suggesting that surfactant is not constantly removed.