Incidence and risk factors of pediatric post-bronchoscopy fever in west China: a retrospective study

Post-bronchoscopy fever (PBF) is a common complication in pediatrics without clear causative reasons. It can affect the rehabilitation of children, increase hospitalization costs, and lead to stress and anxiety in parents. Yet, there are no direct strategies to prevent its occurrence, and data on Chinese patients are limited. This study evaluated the incidence and risk factors associated with PBF in children from West China. The data of children who underwent bronchoscopy from January 2019 to December 2019 in West China Second University Hospital were retrieved. Their demographic characteristics, bronchoscopic results, temperature change after bronchoscopy, and associated indicators were assessed. Differences were compared using the paired t-test, chi-squared test, or Fisher’s exact test, as appropriate. Risk factors associated with PBF were calculated using multivariate logistic regression analyses.In total, the data of 867 patients were retrieved for final analysis. Of them, 88 patients had PBF, with an incidence rate of 10.15%. General anesthesia (odds ratio (OR) = 1.855, 95% confidence interval (CI): 1.482, 2.321) and length of procedure (OR = 1.02, 95% CI: 1.00, 1.03) were identified as risk factors for PBF in pediatrics. This study found that the type of anesthesia and length of procedure were risk factors for PBE in children from West China.

Pediatric; Fever; Bronchoscopy; Risk factors

[1] Schramm D, Yu Y, Wiemers A, Vossen C, Snijders D, Krivec U, et al. Pediatric flexible and rigid bronchoscopy in European centers-availability and current practice. Pediatric Pulmonology. 2017; 52: 1502–1508.

[2] Terkawi RS, Altirkawi KA, Terkawi AS, Mukhtar G, Al-Shamrani A. Flexible bronchoscopy in children: utility and complications. International Journal of Pediatrics and Adolescent Medicine. 2016; 3: 18–27.

[3] Leiten EO, Martinsen EMH, Bakke PS, Eagan TML, Grønseth R. Complications and discomfort of bronchoscopy: a systematic review. European Clinical Respiratory Journal. 2016; 3: 33324.

[4] Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British thoracic society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013; 68: i1–i44.

[5] Hackner K, Riegler W, Handzhiev S, Bauer R, Veres J, Speiser M, et al. Fever after bronchoscopy: serum procalcitonin enables early diagnosis of post-interventional bacterial infection. BMC Pulmonary Medicine. 2017; 17: 156.

[6] Joseph L, Goldberg S, Cohen S, Picard E. Ibuprofen does not prevent postbronchoscopy fever in children undergoing broncho‐alveolar lavage. Pediatric Pulmonology. 2020; 55: 2737–2741.

[7] Ko ER, Philipson CW, Burke TW, Cer RZ, Bishop-Lilly KA, Voegtly LJ, et al. Direct-from-blood RNA sequencing identifies the cause of post-bronchoscopy fever. BMC Infectious Diseases. 2019; 19: 905.

[8] Sharif-Kashani B, Shahabi P, Behzadnia N, Mohammad-Taheri Z, Mansouri D, Masjedi MR, et al. Incidence of fever and bacteriemia following flexible fiberoptic bronchoscopy: a prospective study. Acta Medica Iranica. 2010; 48: 385–388.

[9] Schellhase DE, Tamez JR, Menendez AA, Morris MG, Fowler GW, Lensing SY. High fever after flexible bronchoscopy and bronchoalveolar lavage in noncritically ill immunocompetent children. Pediatric Pul-monology. 1999; 28: 139–144.

[10] Ogawa T, Imaizumi K, Hashimoto I, Shindo Y, Imai N, Uozu S, et al. Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy. Respiratory Investigation. 2014; 52: 153–159.

[11] Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, et al. Interventional bronchoscopy. American Journal of Respiratory and Critical Care Medicine. 2020; 202: 29–50.

[12] Miller RJ, Casal RF, Lazarus DR, Ost DE, Eapen GA. Flexible bronchoscopy. Clinics in Chest Medicine. 2018; 39: 1–16.

[13] Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, et al. ERS statement: interventional bronchoscopy in children. European Respiratory Journal. 2017; 50: 1700901.

[14] Expert Group on pediatric respiratory endoscopy diagnosis and treatment, HHRDC. Guideline of pediatric flexible bronchoscopy in China. Chinese Journal of Applied Clinical Pediatrics. 2018; 33: 983–989. (In Chinese)

[15] Expert Group on pediatric respiratory endoscopy diagnosis and treatment, HHRDC. Expert consensus on respiratory interventional diagnosis and treatment of airway foreign bodies in children in China. Chinese Journal of Applied Clinical Pediatrics. 2018; 33: 1392–1402. (In Chinese)

[16] Carlens J, Fuge J, Price T, DeLuca DS, Price M, Hansen G, et al. Complications and risk factors in pediatric bronchoscopy in a tertiary pediatric respiratory center. Pediatric Pulmonology. 2018; 53: 619–627.

[17] Meduri GU, Stover DE, Greeno RA, Nash T, Zaman MB. Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections. Chest. 1991; 100: 1272–1276.

[18] Mahajan P, Batra P, Thakur N, Patel R, Rai N, Trivedi N, et al. Consensus guidelines on evaluation and management of the febrile child presenting to the emergency department in India. Indian Pediatrics. 2017; 54: 652–660.

[19] American College of Emergency Physicians Clinical Policies Subcom-mittee (Writing Committee) on Pediatric Fever; Mace SE, Gemme SR, Valente JH, Eskin B, Bakes K, Brecher D, et al. Clinical policy for well-appearing infants and children younger than 2 years of age presenting to the emergency department with fever. Annals of Emergency Medicine. 2016; 67: 625–639.

[20] Westra SJ, Karmazyn BK, Alazraki AL, Dempsey ME, Dillman JR, Garber M, et al. ACR appropriateness criteria fever without source or unknown origin—child. Journal of the American College of Radiology. 2016; 13: 922–930.

[21] Green R, Jeena P, Kotze S, Lewis H, Webb D, Wells M, et al. Management of acute fever in children: guideline for community healthcare providers and pharmacists. South African Medical Journal. 2013; 103: 948–954.

[22] China National Clinical Research Center for Respiratory Diseases. Expert consensus on rational use of antipyretics and analgesics in the treatment of fever in children. Chinese Journal of Applied Clinical Pediatrics. 2020; 35: 161–169. (In Chinese)

[23] Shuanghong Luo, Min Shu, Yang Wen, Junjie Ding, Zongrong Gong, Ping Zhang, et al. Evidence-based guidelines for the diagnosis and management of acute fever of unknown etiology in children aged 0 to 5 years in China. Chinese Journal of Evidence Based Pediatrics. 2016; 11: 81–96. (In Chinese)

[24] Mohallem Fonseca MT, Camargos PAM, Abou Taam R, Le Bourgeois M, Scheinmann P, de Blic J. Incidence rate and factors related to post-bronchoalveolar lavage fever in children. Respiration. 2007; 74: 653–658.

[25] Efrati O, Sadeh-Gornik U, Modan-Moses D, Barak A, Szeinberg A, Vardi A, et al. Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease. Pediatric Critical Care Medicine. 2009; 10: 80–84.

[26] Kirvassilis F, Gidaris D, Ventouri M, Zampouri A, Mylona M, Keramidiotis A, et al. Flexible fiberoptic bronchoscopy in Greek children. Hippokratia. 2011; 15: 312–315.

[27] Hemmers T, Nüßlein T, Teig N, Rieger C, Stephan V. Prospective study of fever after bronchoalveolar lavage in children. Klinische PäDiatrie. 2006; 218: 74–78.

[28] Krause A, Hohberg B, Heine F, John M, Burmester GR, Witt C. Cytokines derived from alveolar macrophages induce fever after bronchoscopy and bronchoalveolar lavage. American Journal of Respiratory and Critical Care Medicine. 1997; 155: 1793–1797.

[29] Park JS, Lee CH, Yim JJ, Yang SC, Yoo CG, Chung HS, et al. Impact of antibiotic prophylaxis on postbronchoscopy fever: a randomized controlled study. The International Journal of Tuberculosis and Lung Disease. 2011; 15: 528–535.

[30] Haynes J, Greenstone MA. Fibreoptic bronchoscopy and the use of antibiotic prophylaxis. British Medical Journal. 1987; 294: 1199.