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Routine Fiberoptic Bronchoscopy in Intubated Neonates?

Am J Dis Child. 1990;144(7):746-747. doi:10.1001/archpedi.1990.02150310012005.
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Sir.—I read with interest the article by Shinwell et al1 in the September 1989 issue of AJDC. Recently I reported preliminary results of a prospective study of airway injury in intubated premature infants using a prototype directable tip ultrathin bronchoscope (Olympus Corp of America, New Hyde Park, NY) (outer diameter, 2.2 mm).2 I also found evidence of unsuspected airway injury; however, the clinical significance remains to be defined. Of some concern was the accompanying preliminary results of the safety of the procedure.3 Although I share the authors' conclusions that fiberoptic bronchoscopy is safe in intubated neonates, I found that 31% of procedures resulted in transient oxygen desaturation, 14% resulted in transient bradycardia, and 24% resulted in changes in blood pressure of greater than 10 mm Hg from baseline. A recent study has suggested that increases in blood pressure during endotracheal suctioning of premature neonates is associated


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