Paediatric flexible bronchoscopy and its indications.

Paediatric flexible bronchoscopy (F.B.) with bronchoalveolar lavage (B.A.L.) is an increasingly important investigation. Retrospective review of 180 FB performed over a 5 year period by a single operator was undertaken. Common indications included recurrent lower respiratory tract infections (n = 92, 51%), persistent atelectasis (n = 43, 24%), persistent infiltrates (n = 18, 10%) and persistent consolidation (n = 17, 9%). Normal airway anatomy was identified in the majority (n = 154, 85.5%). Bronchomalacia was identified in 22 cases (12%). Thick purulent secretions were seen in 40 bronchoscopies (22%). Commonest organisms cultured on BAL were H. influenza (n = 22, 12.2%), Streptococcus Pneumoniae (n = 18, 10%) and Staph aureus (n = 9, 5%). Cytomegalo virus (C.M.V.), (n = 4, 2%), candida (n = 1, 0.5%) and aspergillus fumigatus were identified (n = 7, 4%). Bronchoscopic findings frequently guided management (n = 90, 51%). No significant complications occurred. Flexible bronchoscopy procedure, patient and equipment care were in adherence with best practice guidelines. Paediatric F.B. is a safe and useful procedure when clinically indicated.