Introduction: This study aims to (1) describe the indication and diagnoses of flexible bronchoscopy (FB) in neonates, as well as the subsequent management, (2) evaluate the safety profile of neonatal FB and (3) review any change in demographic factors and outcomes on the neonatal FB performed in the research period. Methods: This is a single centre retrospective hospital cohort reviewing FB performed on neonates with chronological age less than 29 days, between 1 st January 2001 and 31 st December 2021. Data on background characteristics, indications, adverse events during procedure, diagnoses and subsequent interventions were collected and analysed. Result: One hundred and fifty-three FB performed on 148 neonates were included. Clinical upper airway obstruction (UAO) was the most common indication for FB, accounting for 64.9% of all subjects. Malacic airway disease (62.8%) was the most common diagnosis after FB, followed by laryngitis (9.5%). Negative findings accounted for 10.1%. Desaturation was the only reported adverse event, occurred in 18 (11.8%) out of 153 FB procedures. Twenty-six (17.6%) infants had surgical intervention after FB, of which 13 out of 93 (14%) infants with malacic airway disease received laryngoscopic supraglottoplasty. Across the study period, there were increasing trends on the number of bronchoalveolar lavage performed and on the chronological age of infants at the time of FB. Conclusion: This study observed that neonatal FB is a safe and useful procedure with limited adverse effect, which helps to delineate the underlying pathologies and provide a guide on further management approach.
