Flexible bronchoscopy in preterm infants with bronchopulmonary dysplasia: findings and complications in a matched control study

Bronchopulmonary dysplasia (BPD) poses a significant challenge as the most common late morbidity of preterm infants. This study aimed to evaluate airway abnormalities in infants with BPD who underwent flexible bronchoscopy (FB) to gain insights into the prevalence of upper airway obstruction and associated complications. A retrospective case–control study was conducted on BPD patients who underwent FB at a tertiary center between 2013 and 2023. BPD patients were matched (1:3) with a reference group based on age, gender, and ethnicity, who also had undergone FB. Demographic data, comorbidities, indications for FB, findings, and complications during and after FB were collected. The study included 50 BPD patients (mean age 1.26 ± 0.9 years, 58% males), and 150 controls. As expected, BPD patients had a lower gestational age, lower birth weight, and longer hospitalizations and were treated with more medications. Abnormal bronchoscopy findings were significantly more common in the BPD group compared to the reference group, with an increased rate of turbinate hypertrophy (OR [95% CI]: 3.44 [1.27–9.37], P = 0.014), adenoid hypertrophy (OR: 2.7 [1.38–5.29], P = 0.004), lingual tonsils (OR: 5.44 [1.29–27.4], P = 0.0024), subglottic stenosis (OR: 6.95 [2.08–27.1], P = 0.002), and tracheomalacia (OR: 2.98 [1.06–8.19], P = 0.034). Complications including desaturation (OR: 3.89 [1.32–11.7], P = 0.013) and PICU admission (OR: 16.6 [2.58–322], P = 0.011) were more frequent in the BPD than in the reference group.

Conclusion: The study revealed a high prevalence of structural anomalies leading to upper airway obstruction and complications in infants with BPD undergoing FB. These findings emphasize the importance of careful consideration and preparation for bronchoscopic procedures in this vulnerable population.