The Indian Journal of Pediatrics

, Volume 84, Issue 9, pp 681–684 | Cite as

Flexible Bronchoscopy in Non-resolving Pneumonia

  • Javeed Iqbal Bhat
  • Wasim Ahmad Wani
  • Qazi Iqbal Ahmad
  • Bashir Ahmad Charoo
  • Syed Wajid Ali
  • Ambreen Ali Ahangar
  • Muzafar Ahmad
Original Article

Abstract

Objective

To study the utility of diagnostic flexible bronchoscopy and bronchoalveolar lavage (BAL) in children with non-resolving pneumonia.

Methods

This was a cross-sectional study conducted in a tertiary care hospital from July 2015 through June 2016. Fifty-two consecutive children of both genders from 1 mo to 14 y of age with a diagnosis of non-resolving pneumonia were included. Flexible bronchoscopy was done in all patients with or without bronchoalveolar lavage (BAL). BAL was sent for gram staining, culture, gene expert™ and lipid laden macrophages examination. Main outcome measures were to find any morphological abnormality in the tracheobronchial tree and organism profile of a positive BAL culture.

Results

During the period of 12 mo, 52 consecutive patients of non-resolving pneumonia were enrolled. Median (IQR) age of the study population was 12 (68.8) mo. Mean ± SD duration of illness was 22.7 ± 5.6 d. Flexible bronchoscopy was found to be very safe and effective tool that directly led to definitive diagnosis in 30.7% of cases. It was positive for different organisms in 22 (52.3%) children. Neglected foreign body was seen in five patients.

Conclusions

Non-resolving pneumonia is often an area of clinical dilemma. Bacterial infections are the commonest etiology. Non-infectious causes like tracheobronchomalacia and foreign body aspiration are other important etiologies to be looked for. Early bronchoscopy and bronchoalveolar lavage analysis can play a crucial role in the evaluation of these patients and may provide an important clue or strongly support the specific diagnosis.

Keywords

Bronchoalveolar lavage Bronchoscopy Non resolving pneumonia 

References

  1. 1.
    Leowski J. Mortality from acute respiratory infections in children under 5 years of age: global estimates. World Health Stat Q. 1986;39:138–44.PubMedGoogle Scholar
  2. 2.
    United Nations Inter Agency Group for Child Mortality Estimation. Levels and Trends in Child Mortality: Report 2014. New York: UNICEF, WHO, the World Bank, United Nations Population Division; 2014.Google Scholar
  3. 3.
    Global Health Observatory. Proportions of Child Deaths by Cause. Geneva: WHO. Available at: http://www.who.int/gho/child_ health/en/index.html. Accessed 24 July 2014.
  4. 4.
    Kirtland SH, Winterbauer RH. Slowly resolving, chronic, and recurrent pneumonia. Clin Chest Med. 1991;12:303–18.PubMedGoogle Scholar
  5. 5.
    Eigen H, Laughlin JJ, Homrighausen J. Recurrent pneumonia in children and its relationship to bronchial hyperreactivity. Pediatrics. 1982;70:698–704.PubMedGoogle Scholar
  6. 6.
    Godfrey S, Avital A, Maayan C, Rotschild M, Springer C. Yield from flexible bronchoscopy in children. Pediatr Pulmonol. 1997;23:261–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Kumar M, Biswal N, Bhuvaneswari V, Srinivasan S. Persistent pneumonia: underlying cause and outcome. Indian J Pediatr. 2009;76:1223–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Owayed AF, Campbell DM, Weng EE. Underlying causes of recurrent pneumonia in children. Arch Pediatr Adolesc Med. 2000;154:190–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Gokdemir Y, Cakir E, Kut A, et al. Bronchoscopic evaluation of unexplained recurrent and persistent pneumonia in children. J Paediatr Child Health. 2013;49:E204–7.Google Scholar
  10. 10.
    De Baets F, De Schutter I, Aarts C, et al. Malacia, inflammation and bronchoalveolar lavage culture in children with persistent respiratory symptoms. Eur Respir J. 2012;39:392–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Passàli D, Lauriello M, Bellussi L, Passali G, Passali F, Gregori D. Foreign body inhalation in children: an update. Acta Otorhinolaryngol Ital. 2010;30:27–32.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Eber E, Zach M. Flexible fiberoptic bronchoscopy in pediatrics--an analysis of 420 examinations. [Article in German]. Wien Klin Wochenschr. 1995;107:246–51.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2017

Authors and Affiliations

  • Javeed Iqbal Bhat
    • 1
  • Wasim Ahmad Wani
    • 1
  • Qazi Iqbal Ahmad
    • 1
  • Bashir Ahmad Charoo
    • 1
  • Syed Wajid Ali
    • 1
  • Ambreen Ali Ahangar
    • 2
  • Muzafar Ahmad
    • 1
  1. 1.Department of PediatricsSKIMSSrinagarIndia
  2. 2.Department of AnesthesiaGMCSrinagarIndia

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