Frequency and type of airway injury identified by bronchoscopic examination in newborns with prolonged endotracheal intubation in a neonatal intensive care unit

Background. Endotracheal intubation and mechanical ventilation are frequently use resources in the Neonatal Intensive Care Unit. Higher mortality has been observed as a result of complications. We undertook this study to report the frequency and type of airway injury in newborns with prolonged endotracheal intubation who underwent bronchoscopy examination. Methods. Newborns (n = 150) who were intubated endotracheally for >= 5 consecutive days and who underwent bronchoscopy were included. We recorded the following variables: gestational age, birth weight, indications for intubation, size of endotracheal tube, number of reintubations, intubation length, indication for bronchoscopy, bronchoscopic findings, type of treatment for airway injury, and number of bronchoscopies. Results. The main indication for bronchoscopy was atelectasis (persistent and/or recurrent); 96% of newborns had at least one injury. The most frequent were inflammatory type (67.3%), malacia (39.3%), and stenosis (28.7%). The most injured anatomic structures were the bronchi (31.6%), larynx (24%), and trachea (22%). For 126 patients, primary medical treatment was steroids. For 21 patients (14%), dilatation was performed under bronchoscopy; and for 7 (4.6%) patients, tracheostomy was performed. Conclusions. The most frequent injuries were inflammatory-type. Persistent atelectasis was the principal clinical manifestation; therefore, it should be considered as an indication of bronchoscopic exploration to identify airway injury in newborns with prolonged endotracheal intubation.