Bronchoscopic findings, microbiological profile, and clinical impact of flexible bronchoscopy in children with persistent pneumonia: a five-year experience from an Eastern Indian tertiary care centre

Background Persistent pneumonia in children, characterized by persistent respiratory symptoms and unresolved radiological abnormalities despite appropriate therapy, remains a significant diagnostic challenge. Flexible bronchoscopy allows direct airway visualization, bronchoalveolar lavage (BAL) sampling, and therapeutic intervention; however, data from low- and middle-income countries remain limited. Objective To evaluate bronchoscopic findings, BAL microbiological profile, procedural safety, and the clinical impact of flexible bronchoscopy in children with persistent pneumonia. Methods This retrospective observational study was conducted at a tertiary pediatric referral centre in Eastern India between January 2019 and December 2024. Children aged 1 month to 14 years with persistent pneumonia who underwent flexible bronchoscopy were included. Demographic characteristics, radiological findings, bronchoscopic abnormalities, BAL microbiology, multiplex respiratory polymerase chain reaction (PCR) results, therapeutic interventions, complications, and post-bronchoscopy management changes were analyzed. Results Seventy-five children were included (mean age 4.5 ± 3.2 years; 60% male). Abnormal bronchoscopic findings were identified in 61 children (81.3%). The most common abnormalities were mucus plugging or thick secretions (30.7%), airway malacia (17.3%), and endobronchial inflammation (14.7%). Foreign body aspiration was identified in six children (8.0%). BAL culture was positive in 12.0% of patients, while multiplex respiratory PCR detected pathogens in 29.3%, with Mycoplasma pneumoniae being the most frequently identified organism. Bronchoscopic interventions were performed in 35 children (46.7%), and findings resulted in modification of subsequent clinical management in 33 children (44.0%). Children with lobar collapse were more likely to have mucus plugging requiring intervention ( p = 0.01). No major procedure-related complications were observed. Conclusion Flexible bronchoscopy frequently identifies clinically relevant airway abnormalities in children with persistent pneumonia and provides valuable microbiological and therapeutic information. In appropriately selected patients, bronchoscopy contributes meaningfully to clinical decision-making while maintaining an excellent safety profile.