Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia
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 clini...
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Elsevier
2021-03-01
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| Series: | Pediatrics and Neonatology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1875957220302023 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Chen-Chu Liao |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-0aaf4a57cf0c4f88be9850b57178bfeb |
| institution | OA Journals |
| issn | 1875-9572 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
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| series | Pediatrics and Neonatology |
| spelling | doaj-art-0aaf4a57cf0c4f88be9850b57178bfeb2025-08-20T02:03:08ZengElsevierPediatrics and Neonatology1875-95722021-03-0162219520110.1016/j.pedneo.2020.11.008Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumoniaChen-Chu Liao0Ming-Horng Tsai1Shen-Hao Lai2Mei-Yin Lai3Shih-Ming Chu4Hsuan-Rong Huang5Kai-Hsiang Hsu6Ming-Chou Chiang7Ren-Huei Fu8Jen-Fu Hsu9Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi, Taiwan; Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Corresponding author. Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Guishan District, Taoyuan, 333, Taiwan. Fax: +886 3 3288957.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.http://www.sciencedirect.com/science/article/pii/S1875957220302023mortalitymultidrug resistant pathogensNB-BALneonatesventilator-associated pneumonia |
| spellingShingle | 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 Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia Pediatrics and Neonatology mortality multidrug resistant pathogens NB-BAL neonates ventilator-associated pneumonia |
| title | Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia |
| title_full | Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia |
| title_fullStr | Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia |
| title_full_unstemmed | Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia |
| title_short | Safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator-associated pneumonia |
| title_sort | safety and clinical application of nonbronchoscopic bronchoalveolar lavage in preterm neonates with clinical ventilator associated pneumonia |
| topic | mortality multidrug resistant pathogens NB-BAL neonates ventilator-associated pneumonia |
| url | http://www.sciencedirect.com/science/article/pii/S1875957220302023 |
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