Flexible bronchoscopy in pediatric atelectasis: bronchoscopic findings, management changes, and factors associated with radiographic resolution

Background. Flexible bronchoscopy (FB) is widely used in children with atelectasis; however, the optimal timing of FB and the influence of underlying disease on radiographic resolution remain uncertain. We aimed to describe bronchoscopic and microbiological findings, subsequent management changes, radiographic outcomes, and factors associated with atelectasis resolution in children who underwent FB. Methods. This retrospective cohort included 108 children (0–18 years) who underwent FB for atelectasis between 2017 and 2022 with chest radiograph-based follow-up. Outcomes were immediate radiographic response and final radiographic status. An exploratory Cox model assessed time to complete resolution and included detection-to-FB interval, macroscopic pathological findings, congenital heart disease, primary ciliary dyskinesia, immunodeficiency, asthma and cystic fibrosis. Results. Median age at FB was 4.9 years (IQR: 2.5–8.8; range: 14 days to 18 years). 67/108 patients (62.0%) had underlying disorders. Macroscopic pathological findings were observed in 95.4%. Bronchoalveolar lavage cultures were positive in 75/105 patients (71.4%) and additional treatment was administered in 67/108 patients (62.0%). At final radiographic status, complete, partial, and no resolution were observed in 44/108 (40.7%), 30/108 (27.8%), and 34/108 patients (31.5%), respectively. In the exploratory Cox model, each 30-day increase in detection-to-FB interval was associated with a lower hazard of complete resolution (HR: 0.88, 95% CI: 0.80–0.98; p=0.018), but this association was attenuated after excluding intervals >365 days (p=0.169). Procedure-related complications occurred in 4/108 patients (3.7%). Conclusions. In selected children undergoing FB for atelectasis, bronchoscopy frequently revealed clinically relevant bronchoscopic and microbiological findings, informed subsequent management, and was followed by partial or complete radiographic resolution in more than two-thirds of patients. Although the timing-related findings should be interpreted cautiously, particularly because the association was attenuated in sensitivity analysis, this study supports the role of FB as a complementary diagnostic and management-guiding tool in pediatric atelectasis.