title: Safety of bronchoalveolar lavage in young children with cystic fibrosis.
abstract: OBJECTIVE
  Our aim was to determine the safety of BAL in young children <6 years with CF.
  
  
  METHODS
  As part of a multi-center study of BAL-directed therapy, children with CF < 6 years had one or more BALs between September 1999 and December 2005. Adverse events were recorded intraoperatively and for 24 hr thereafter. Clinical characteristics before BAL, findings at bronchoscopy and BAL results were assessed as risk factors for adverse events.
  
  
  RESULTS
  333 BALs were conducted in 107 (56 males) children, median age 23.5 (range 1.6-67.5) months, including 170 (51%) for pulmonary exacerbation. 29 BALs (8.7%) were followed by fever >or=38.5 degrees C and 10 (3%) had clinically significant episodes (five intraoperative hemoglobin desaturations to <90% requiring intervention, one tachyarrhythmia, two needing post-operative supplemental oxygen, one hospitalization for stridor). Two contaminated bronchoscopes were detected. 180 minor adverse events were recorded in 174 (52%) BAL procedures (137 altered cough, 41 fever <38.5 degrees C). Low percentage BAL return (P = 0.002) and focal bronchitis (P = 0.02) were associated with clinically significant deterioration. Multivariable analysis identified Streptococcus pneumoniae (OR 22.3; 95% confidence interval (CI); 6.9,72), Pseudomonas aeruginosa (OR 2.4; 95% CI 1.0, 5.8), respiratory signs (OR 5.0; 95% CI 1.7, 14.6) and focal bronchitis (OR 5.9; 95% CI 1.2, 29.8) as independent risk factors for post-bronchoscopy fever >or=38.5 degrees C.
  
  
  CONCLUSIONS
  Adverse events are common with BAL in young CF children, but are usually transient and well tolerated. Parents should be counseled that signs of a pre-existing lower respiratory infection are associated with increased risk of post-BAL fever.
authors.affiliation: Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Australia. claire_wainwright@health.qld.gov.au
authors.forename: Claire E
authors.initials: CE
authors.lastname: Wainwright
authors.forename: Keith
authors.initials: K
authors.lastname: Grimwood
authors.forename: John B
authors.initials: JB
authors.lastname: Carlin
authors.forename: Suzanna
authors.initials: S
authors.lastname: Vidmar
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Cooper
authors.forename: Paul W
authors.initials: PW
authors.lastname: Francis
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Byrnes
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Whitehead
authors.forename: A James
authors.initials: AJ
authors.lastname: Martin
authors.forename: Ian F
authors.initials: IF
authors.lastname: Robertson
authors.forename: David M
authors.initials: DM
authors.lastname: Cooper
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Dakin
authors.forename: Ian B
authors.initials: IB
authors.lastname: Masters
authors.forename: R John
authors.initials: RJ
authors.lastname: Massie
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Robinson
authors.forename: Sarath
authors.initials: S
authors.lastname: Ranganathan
authors.forename: David S
authors.initials: DS
authors.lastname: Armstrong
authors.forename: Lyndall K
authors.initials: LK
authors.lastname: Patterson
authors.forename: Colin F
authors.initials: CF
authors.lastname: Robertson
mesh_terms: D018893:Bronchoalveolar Lavage / Q000009:adverse effects*; D001999:Bronchoscopy; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012307:Risk Factors