Experience with Flexible Bronchoscopy for Non-COVID-19 Indications in Pediatric Patients During the COVID-19 Pandemic

<bold>Background and aim:</bold> Flexible bronchoscopy (FB) is an aerosol-generating procedure (AGP) that increases the risk of transmission of the SARS-CoV-2 virus. This study evaluated the use, indications, outcomes, and safety of flexible bronchoscopy in pediatric patients for non-COVID-19 reasons during the COVID-19 pandemic. <bold>Methods:</bold> Patients who underwent FB for non-COVID-19 indications during the COVID-19 pandemic in the pediatric pulmonology clinic of a tertiary care children's hospital were retrospectively evaluated. These patients had no clinical symptoms suggestive of COVID-19 and tested negative for SARS-CoV-2 by RT-PCR of nasopharyngeal and throat swabs within 24 hours before the procedure. All FBs were performed in the operating room and all healthcare workers performing the procedure wore PPE, including medical masks, gloves, gowns, and eye protection. <bold>Results:</bold> Between March 2020 and April 2022, 167 pediatric patients underwent FB for non-COVID-related reasons. The most common reasons for FB were foreign body aspiration (22.7%), stridor (10.1%), and atelectasis (8.9%). No COVID-19 symptoms were observed in any patients on the 1st or 10th day after FB. Out of 52 patients who had a COVID-19 PCR test within a month after FB, only 1 tested positive at week 3 post-procedure. Additionally, none of the healthcare workers in the FB team showed symptoms or tested positive for COVID-19. <bold>Conclusion:</bold> A bronchoscopy protocol with safety measures has reduced COVID-19 transmission risk, enabling safe performance of FBs for non-COVID-19 reasons in pediatric patients during the pandemic. This experience is valuable for future similar situations.