Lesson of the Week: Pulmonary hypoplasia presenting as persistent tachypnoea in the first few months of life

Persistent tachypnoea in neonates

“…In this issue of the BMJ Aiton et al raise the possibility that primary pulmonary hypoplasia might be more common than was previously thought (p1149) 2. They present the cases of four neonates in whom mild pulmonary hypoplasia was missed despite persistent tachypnoea.…”

“…In the short term this may not be especially important as there is no specific treatment for hypoplastic lungs and, despite anecdotal reports,9 no treatment is known to improve lung growth. Many cases will improve with time, as noted by Aiton et al2 The longer term outlook is still unresolved, and good longitudinal studies are needed to determine whether mild pulmonary hypoplasia carries a risk of increased respiratory problems in later life.…”

“…The chest x ray picture will help in making the diagnosis in most, though not all, cases 2. In the absence of specific clues further investigation should include an electrocardiogram and an echocardiogram to detect a possible occult cardiac cause.…”

“…Severe cases can be detected by clinical observation or by chest x ray, particularly if the condition is unilateral 5. Aiton et al used the measurement of lung volume to assist in diagnosing their milder cases 2. Given the influence of other factors on lung volume, basing the diagnosis on this measurement alone would be unwise.…”

Prediction and Prevention of Abnormal Antenatal Lung Growth

“…There is a spectrum of severity of pulmonary hypoplasia. Some survivors may require many months of supplementary oxygen and recurrent respiratory symptoms are common [8], but infants with mild pulmonary hypoplasia only suffer a raised respiratory rate in infancy [9]. It is important, therefore, that pulmonary hypoplasia and the severity of the condition is accurately diagnosed antenatally to enable practitioners and parents to make informed decisions regarding whether termination of the pregnancy or in utero intervention is appropriate for their *Address correspondence to this author at the Regional Neonatal Intensive Care Centre, 4 th Floor Golden Jubilee Wing, King's College Hospital, Denmark Hill, London, SE5 9RS, USA; Tel: 020 7346 3037; Fax: 020 7346 8284; E-mail: anne.greenough@kcl.ac.uk baby.…”