Management of Air Leaks in the Newborn

Abstract

Background: Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing incidence, it continues to have a high morbidity and mortality rate. This makes PIE one of the most severe respiratory complications to affect a newborn. Air leaks occur when there is overdistension of the terminal airways or alveoli, which results in air dissecting into extra-alveolar spaces. Recognizing the signs of air leaks is paramount to allow for appropriate diagnosis and treatment of the newborn to improve morbidity and mortality. Treatment modalities range from positioning the newborn in the decubitus position to surgical intervention. Purpose: To summarize current evidence on the pathophysiology, risk factors, diagnosis, treatment, and management of PIE and pneumothorax. Data Sources: Two databases were systematically reviewed with key words later. Articles in English with date restrictions from 2016 to current were included. Study Selection: Inclusion criteria of randomized controlled trials, case studies/reports, and review articles were utilized. Twenty articles, primarily case reports and studies, were reviewed. Data Extraction: Guidelines for data abstraction were followed via independent extraction by a single observer. Results: Qualitative results were utilized to formulate current treatment of air leaks. Implications for Practice: This article provides guidance for frontline neonatal providers on current treatment and management of air leaks in the newborn population.

Respiratory Support Effects over Time on Regional Lung Ventilation Assessed by Electrical Impedance Tomography in Premature Infants

“…In our study, intubated patients were ventilated with significantly larger EELZ (which strongly correlates with end-expiratory lung volume) than those on non-invasive respiratory support [14]. This finding aligns with physiological principles, as the regulation of FRC under positive PEEP can be more effectively controlled through mechanical ventilation compared to non-invasive modes [15,16]. Other studies also demonstrated that respiratory support results in increased EELV over time [17].…”

“…Some studies also indicate that HFNC provides TV similar to CPAP [ 24 ]. Our findings of larger EELZ and DeltaZ in intubated patients could explain why mechanical ventilation is associated with higher rates of lung injury and pulmonary air leaks [ 15 , 25 , 26 ], although some data for pneumothorax rate between therapies is conflicting [ 27 ]. Nonetheless, measuring volume and distending pressures in neonates is difficult and is known to have wide interpatient as well as intrapatient variation, which also might influence observed differences [ 28 ].…”

Case Report: Neurally adjusted ventilatory assist as an effective rescue treatment for pulmonary interstitial emphysema in extremely low birth weight infants

“…The fundamental treatment approach for PIE involves utilizing gentle ventilation techniques to decrease barotrauma and volutrauma ( 28 ). This includes non-invasive ventilation, volume control, or high-frequency ventilation, all of which have been found effective in minimizing the development of PIE ( 8 , 29 ).…”