Fiberoptic Endotracheal Intubation Through an Ultra-Thin Bronchoscope with Suction Channel in a Newborn with Difficult Airway

Management of the airway may be difficult in newborns with craniofacial and neck malformations (1). Previous experiences with flexible endoscopic intubation in neonates have shown encouraging results, but a number of limitations, such as no directional control at the tip or lack of an operative channel, were also reported (2,3). We describe a successful intubation by a new 2.5-mm fiberoptic bronchoscope with a 1.2-mm suction channel in a newborn with difficult airway. A 2300-g infant, born at 35 wk of gestation after an urgent cesarean delivery for fetal distress, needed cardiopulmonary resuscitation at birth. Endotracheal intubation was achieved only after several attempts with a 3.0-mm tube inserted nasotracheally. On arrival to our unit, physical examination showed dysmorphic face, micrognathia, and arthrogryposis. A gross air leak around the endotracheal tube (ETT) prevented an adequate ventilation of the patient. We decided to explore the patient’s larynx before exchanging the ETT with a larger one, but micrognathia did not allow proper visualization by conventional laryngoscopy. Thus, we inserted a 3.5-mm ETT using a fiberoptic flexible bronchoscope (Richard Wolf-GmbH, Knittlingen, Germany). This endoscope has a 2.5-mm outer diameter, a 1.2-mm instrument channel, an angle of deflection at the tip of 160° up and 130° down, and a working length of 450 mm. During the procedure, we could remove secretions and provide topical anesthesia via the suction channel of the endoscope. No complications were noted.We believe this new ultra-thin bronchoscope may be useful in newborns and small infants when a difficult intubation is anticipated or, alternatively, when lower airway evaluation, suctioning, bronchoalveolar lavage, or supplemental oxygen delivery during intubation is required.