Bronchoalveolar Lavage in Pediatric Patients

Although bronchoalveolar lavage (BAD has not been standardized in the pediatric age group and universally used reference values for BAL fluid (BALF) constituents are lacking, it is increasingly used as a clinical and research tool in children. Generally. BAL is performed as part of flexible bronchoscopy; for intubated infants and children nonbronchoscopic techniques have been developed. Many factors such as the site of lavage. the volume of the fluid injected, the number of aliquots. the size of the bronchoscope (or that of the catheter). and the dwell time may influence the nature of the recovered fluid. The processing of the aspirated BALF (e.g., separate vs. pooled aliquots. filtration) is even more variable than the methods used to obtain the specimens. For ethical reasons, reference values for cellular and noncellular components of BALF are difficult to obtain in the pediatric age group. Thus, in children only limited information, especially about noncellular constituents of BALF. exists. In general, total and differential cell counts in children seem to be similar to those in adults. However, lymphocyte subsets were found to be quite different. BAL has a well-established role in the diagnosis of pulmonary infections, especially in immunocompromised children. In contrast, the role of BAL in children with noninfectious interstitial lung disease still has to be defined. The indications for a therapeutic BAL include airway obstruction with inspissated secretions and alveolar proteinosis. BAL is regarded as a safe and effective procedure in infants and children, even in those who are critically ill, and there are no absolute contraindications as long as the potential benefits outweigh the potential risks. For both bronchoscopic and nonbronchoscopic BAL; standardization of the lavage procedure, procedures for processing the BALF and the expression of the results of BALF analysis are urgently needed.