Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia

Chen-Chu Liao; Ming-Horng Tsai; Shen-Hao Lai; Mei-Yin Lai; Shih-Ming Chu; Hsuan-Rong Huang; Kai-Hsiang Hsu; Ming-Chou Chiang; Ren-Huei Fu; Jen-Fu Hsu

doi:10.1016/j.pedneo.2020.11.008

Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia

Pediatr Neonatol. 2021 Mar;62(2):195-201. doi: 10.1016/j.pedneo.2020.11.008. Epub 2020 Dec 13.

Authors

Affiliations

¹ Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
² Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
³ College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
⁴ Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁵ Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: jeff0724@gmail.com.

PMID: 33413988
DOI: 10.1016/j.pedneo.2020.11.008

Abstract

Background: The safety and clinical application of nonbronchoscopic bronchoalveolar lavage (NB-BAL) in preterm neonates with ventilator-associated pneumonia (VAP) have not been fully investigated, and limited data on the feasibility of this method are available.

Methods: Premature infants with clinically suspected VAP between October 2017 and June 2019 were enrolled, and NB-BAL was performed. The tolerance and safety of NB-BAL were prospectively recorded during the procedure, and the clinical applications of NB-BAL were observed.

Results: A total of 46 NB-BAL procedures were performed in 31 neonates with clinically suspected VAP. The median (interquartile range) gestational age and birth body weight were 28.7 (26.7-31.3) weeks and 1055.0 (817.0-1475.0) grams, respectively. Overall, all episodes of the procedure were well tolerated, with only 9 (19.5%) episodes showing transient desaturation and one patient (2.2%) showing bradycardia during the NB-BAL procedure. There were no impairments in arterial blood gas, cardiopulmonary parameters or respiratory severity scores after NB-BAL. No significant complications occurred in any of the patients who received NB-BAL. No chronic comorbidities affected the safety and clinical application of NB-BAL in these mechanically ventilated preterm neonates. NB-BAL yielded a diagnosis in 32 (69.6%) of these VAP episodes. Staphylococcus aureus was the most common isolated bacterium and accounted for 7 (15.2%) confirmed cases of VAP in our study, followed by polymicrobial microorganisms (n = 6, 13.0%). The appropriate antibiotics were prescribed and modified according to the NB-BAL results in 25 (54.3%) cases of VAP.

Conclusions: NB-BAL is a safe and clinically applicable method for determining the etiology and diagnosis of VAP in the NICU, even in extremely preterm neonates with major chronic comorbidities. Further studies to investigate the diagnostic accuracy and impact of NB-BAL on VAP treatment in neonates are warranted in the future.

Keywords: NB-BAL; mortality; multidrug resistant pathogens; neonates; ventilator-associated pneumonia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Bronchoalveolar Lavage / methods*
Bronchoalveolar Lavage Fluid / microbiology
Feasibility Studies
Female
Humans
Infant
Infant, Newborn
Infant, Premature
Male
Pneumonia, Bacterial / diagnosis*
Pneumonia, Bacterial / drug therapy
Pneumonia, Bacterial / microbiology
Pneumonia, Ventilator-Associated / diagnosis*
Pneumonia, Ventilator-Associated / drug therapy
Pneumonia, Ventilator-Associated / microbiology

Substances

Anti-Bacterial Agents