Application of bronchoscopy for differential diagnosis of dyspnea after withdrawal of ventilation in neonates / 中国新生儿科杂志

ABSTRACT

Objective:To study the clinical application of bronchoscopy finding causes of neonatal dyspnea after withdrawal of ventilation and determining intervention strategy.Methods:From November 2018 to August 2021, fiberoptic bronchoscopy results and further treatments of neonates with dyspnea after withdrawal of ventilation in our hospital were retrospectively analyzed.Results:A total of 45 patients experienced dyspnea after withdrawal of ventilation, including 16 cases of bronchial mucositis (35.6%) and 29 cases of extrapulmonary airway obstruction (64.4%). The 29 extrapulmonary airway obstruction cases included 15 cases of subglottic stenosis (11 caused by hyperplastic scar and 4 caused by sputum scab), 6 cases of simple laryngomalacia, 2 cases of nasal stenosis, 2 cases of laryngeal web, 1 case of laryngeal edema, 1 case of vocal cord paralysis, 1 case of vocal cord excrescence and 1 case of airway spasm. 16 patients with bronchial mucositis were cured after airway lavage and oxygen therapy or noninvasive respiratory support. For 11 patients of subglottic stenosis caused by hyperplastic scar, 9 cases were cured using tracheal tube expansion technique and 2 cases were cured with endoscopic intervention. One patient of nasal cavity stenosis, two patients of laryngeal web and one patient of vocal cord excrescence were cured after surgical treatment. The other 14 patients were cured and discharged after conservative treatment.Conclusions:For neonates with dyspnea after withdrawal of ventilation in neonatal intensive care unit (following proper withdrawal process), extrapulmonary airway obstruction should be considered, especially subglottic stenosis after intubation.