Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

Bawa, Pritish; Soontarapornchai, Kultida; Perenyi, Agnes; Goldfisher, Rachelle; Amodio, John

doi:10.1155/2014/429797

Cited by 14 publications

(7 citation statements)

References 16 publications

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“…Pulmonary interstitial emphysema (PIE) is a well known and severe complication in very premature newborns with respiratory distress syndrome (RDS) receiving invasive mechanical ventilation. However, few PIE cases - unilateral or bilateral - have been reported in premature babies exposed to nasal continuous positive airway pressure (nCPAP) [1–7]. So far, there is no standard treatment for unilateral PIE, and several treatment approaches have been reported in literature, including selective unilateral intubation and ventilation [8–12], High Frequency Oscillation Ventilation (HFOV) and High Frequency Jet Ventilation (HJFV) [12–16], Neurally Adjusted Ventilatory Assist (NAVA) [17, 18], and even surgical lobectomy [19–21].…”

Section: Introductionmentioning

confidence: 99%

Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature

et al. 2019

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Background Pulmonary interstitial emphysema (PIE) in very low birth weight infants is a rare but severe complication. Although most of these air leaks develop in mechanically ventilated infants, they have also been reported in infants exposed only to nasal continuous positive airway pressure (CPAP). The optimal treatment for PIE is still under discussion and includes different approaches such as unilateral intubation, high frequency oscillation ventilation and even surgical lobectomy. However, as yet, there has been no report on complete resolution of unilateral PIE by positioning therapy without mechanical ventilation. Case presentation We report the case of a 28 +1 gestational week twin, 990 g birth weight, Apgar 9–10-10. After stabilization with nasal CPAP the baby received surfactant by less invasive surfactant application (LISA) technique in the delivery room after 35 min of life, and continued respiratory support with nasal CPAP. At day 5 X-ray presented unilateral PIE, while pCO 2 increased from 40 mmHg to 55 mmHg and FiO 2 from 0.21 to 0.28 to achieve SpO 2 in the target range of 89–94%. The baby was treated by strict positioning on the affected hemithorax in a special splint while spontaneously breathing on High Flow Nasal Cannula (HFNC). Complete resolution of the unilateral PIE was observed after 96 h. No chronic lung disease developed. Conclusion For unilateral PIE in very preterm infants, positioning on the affected hemithorax without mechanical ventilation is a therapeutic option.

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Section: Introductionmentioning

confidence: 99%

Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature

et al. 2019

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“… 11 However, several authors report on the spontaneous evolution of PIE in preterm neonates even in the absence of invasive ventilation, including a set of twin VLBWI. 9 12 13 14 Prior to the development of PIE, all these cases reported in the literature had clinical and radiological signs of RDS, but were never treated with surfactant. Thus, it is unclear if mechanical ventilation is the main driver in the etiology of PIE or whether early PIE is rather the consequence of missed or delayed surfactant administration.…”

Section: Discussionmentioning

confidence: 99%

Early Pulmonary Interstitial Emphysema in Preterm Neonates—Respiratory Management and Case Report in Nonventilated Very Low Birth Weight Twins

Gronbach

Ehrhardt

Zimmer

et al. 2018

AJP Rep

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Early pulmonary interstitial emphysema in extreme preterm neonates is closely linked with respiratory distress syndrome and exposure to mechanical ventilation. In severe cases, maintaining adequate gas exchange aiming to avoid further lung damage and other neonatal morbidities associated with systemic/pulmonary hypoperfusion, prolonged hypoxia, and respiratory acidosis can be challenging and requires in-depth knowledge into the pathophysiology of the disease. Herein, we report on very low birth weight twins who developed early pulmonary interstitial emphysema during noninvasive respiratory support. We further review the current evidence from the literature, specifically addressing on possible preventive measures and the respiratory management options of this acute pulmonary disease in high-risk neonates.

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“…The differential diagnoses of LPPIE in infants and children include congenital cystic lung disease (such as CCAM), bronchogenic cysts, congenital lobar emphysema, cystic lymphangioma, and infection sequelae . Chest CT is useful for differentiating LPPIE from other cystic lung disease.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary interstitial emphysema due to respiratory syncytial virus infection

Aiyoshi

Masumoto

Shinkai

et al. 2016

Pediatrics International

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Pulmonary interstitial emphysema (PIE) primarily affects premature infants on positive pressure ventilation. PIE is rarely reported in infants and children in the absence of mechanical ventilation and/or associated respiratory infection. We report a case of PIE in a 22-month-old girl who had severe respiratory distress due to respiratory syncytial virus infection. Chest computed tomography showed cystic lung lesions mimicking congenital cystic adenomatoid malformation. The cystic lesions spontaneously resolved after conservative treatment. Based on the clinical course and the chronological changes on imaging, the cystic lung lesions were diagnosed as localized persistent PIE.

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Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

Cited by 14 publications

References 16 publications

Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature

Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature

Early Pulmonary Interstitial Emphysema in Preterm Neonates—Respiratory Management and Case Report in Nonventilated Very Low Birth Weight Twins

Pulmonary interstitial emphysema due to respiratory syncytial virus infection

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