Age-Dependent Patterns in Pediatric Flexible Bronchoscopy: A 5-Year Experience from a Tertiary Center in Southern Taiwan

Abstract Background: Flexible bronchoscopy (FB) has become an essential diagnostic and therapeutic tool. However, age-dependent variations in clinical indications, bronchoscopic findings, and bronchoalveolar lavage (BAL) yield remain underexplored. Methods: We conducted a retrospective chart review of pediatric patients (<18 years) who underwent FB at a tertiary medical center in southern Taiwan between May 2020 and April 2025. Clinical data, bronchoscopic findings, and BAL results were analyzed and stratified by age group. Results: A total of 155 pediatric FB procedures were analyzed, including 57 infants, 76 children, and 22 adolescents. The most common indication overall was unexplained stridor or wheezing (38.1%), predominantly among infants (71.9%). In contrast, chronic cough and radiologic abnormalities were more common in older children and adolescents. The most frequent bronchoscopic findings included airway inflammation (47.1%), laryngomalacia (36.1%), and pharyngomalacia (12.9%), with notable age-related differences in distribution. BAL was performed in 75 patients, yielding positive cultures in 38.6% and viral detection in 9.3%. BAL findings contributed to diagnostic clarification in 60.0% and led to therapeutic modifications in 61.3% of cases. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were the most commonly isolated pathogens, and anaerobic organisms were identified in 12 patients, often in polymicrobial infections. Conclusions: Pediatric FB reveals age-related patterns in clinical presentation and airway pathology. FB, particularly when combined with BAL, offers substantial diagnostic value across pediatric age groups. Early use of FB should be considered in children with persistent or unexplained respiratory symptoms, especially in infants with suspected congenital anomalies or older children with inflammatory airway disease.