Adequacy of Bronchoalveolar Lavage in Decreasing Morbidity in Ventilated Neonates

Early-onset pneumonia is part of generalized sepsis that first manifests at or within hours of birth. Late-onset pneumonia usually occurs after 7 days of age, most commonly in neonatal intensive care units among infants who require prolonged endotracheal intubation because of lung disease. Diagnosis is by clinical and laboratory evaluation for sepsis. Treatment is initial broad-spectrum antibiotics changed to organism-specific drugs as soon as possible. Surveillance studies of nosocomial infections in NICU patients indicate that pneumonia comprises 6.8 to 32.3% of nosocomial infections in this setting. Aim: To establish the incidence, aetiology, risk factors, and outcomes associated with pneumonia using BAL sampling technique in neonates. Material and methods: A cross sectional study carried out at neonatal intensive care unit in a tertiary health care centre in Solapur, thus 28 neonates admitted in NICU and requiring mechanical ventilation were studied for period of 2 years. Bronchoalveolar lavage samples were collected using flexible bronchoscope with two sterile mucus extractor. Isolation of >103 colony-forming unit/mL was required for diagnosis. Results: 79% of neonates had culture positive growth and 21% had culture negative growth Most common pathogen isolated was E coli 25%. The organisms isolated were found to have different sensitivity pattern on the culture report and the patients were treated accordingly. Enlisted here are few of the antibiotics which were found to be sensitive. Conclusion: It’s unique and very effective way to isolate the organism causing respiratory pathology and provide antimicrobial therapy according to susceptibility pattern rather than giving broad spectrum antibiotics for a longer duration and time and increasing incidence for drug resistance.