Predictors of outcome of prematurely born infants with pulmonary interstitial emphysema

Williams, Emma; Dassios, Theodore; Clarke, Paul; Chowdhury, Olie; Greenough, Anne

doi:10.1111/apa.14400

Cited by 9 publications

(9 citation statements)

References 17 publications

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“…It should be noted that in absolute terms, the values of V A / Q that we are reporting are markedly abnormal with a median V A / Q of 0.20 in the whole cohort including survivors and non-survivors. These values are comparable to premature infants with severe bronchopulmonary dysplasia 21 or pulmonary interstitial emphysema 22 and more than four times lower than what would be seen in healthy term infants using the same methodology (median V A / Q : 0.84). 9 , 10 It was also interesting that although a median shunt of 10% was present in our population, the degree of shunt did not discriminate survivors from non-survivors, nor did it change significantly over the course of neonatal intensive care in the infants who survived to discharge.…”

Section: Discussionsupporting

confidence: 52%

“…In our study, we used two retrospectively collected paired points of SpO 2 and F I O 2 , whereas some previous neonatal studies have used 3–5 prospective pairs. 29 , 30 Two pairs, however, have also been used 9 , 21 , 22 as the higher value of SpO 2 would predominantly define the degree of shunt and the lower value of SpO 2 would adequately define the V A / Q . The retrospective nature of our data, finally, might have left us with fewer paired measurements to calculate the V A / Q and shunt within our narrow time window of 4 h compared to prospectively collected data.…”

Section: Discussionmentioning

confidence: 99%

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Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

et al. 2022

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Background We aimed to explore the postnatal evolution of ventilation/perfusion ratio (VA/Q) and right-to-left shunt in infants with congenital diaphragmatic hernia (CDH) and whether these indices predicted survival to discharge. Methods Retrospective cohort study at King’s College Hospital, London, UK of infants admitted with CDH in 10 years (2011–2021). The non-invasive method of the oxyhaemoglobin dissociation curve was used to determine the VA/Q and shunt in the first 24 h of life, pre-operation, pre-extubation and in the deceased infants, before death. Results Eighty-two infants with CDH (71 left-sided) were included with a median (IQR) gestation of 38.1(34.8–39.0) weeks. Fifty-three (65%) survived to discharge from neonatal care. The median (IQR) VA/Q in the first 24 h was lower in the deceased infants [0.09(0.07–0.12)] compared to the ones who survived [0.28(0.19–0.38), p < 0.001]. In the infants who survived, the VA/Q was lower in the first 24 h [0.28 (0.19–0.38)] compared to pre-operation [0.41 (0.3–0.49), p < 0.001] and lower pre-operation compared to pre-extubation [0.48 (0.39–0.55), p = 0.027]. The shunt was not different in infants who survived compared to the infants who did not. Conclusions Ventilation-to-perfusion ratio was lower in infants who died in the neonatal period compared to the ones that survived and improved in surviving infants over the immediate postnatal period. Impact The non-invasive method of the oxyhaemoglobin dissociation curve was used to determine the ventilation/perfusion ratio VA/Q in infants with congenital diaphragmatic hernia (CDH) in the first 24 h of life, pre-operation, pre-extubation and in the deceased infants, before death. The VA/Q in the first 24 h of life was lower in the infants who did not survive to discharge from neonatal care compared to the ones who survived. In the infants who survived, the VA/Q improved over the immediate postnatal period. The non-invasive calculation of VA/Q can provide valuable information relating to survival to discharge.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

et al. 2022

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“…3 Furthermore, PIE development has been related to impaired oxygenation and ventilation efficiency and the oxygenation index during the development of PIE has been shown to be a predictor for death or BPD. 22 Our matched-pairs analysis took all the known major contributing factors to PIE into consideration, such as birthweight, GA and gender. The matching procedure focused on the main confounders of gestational age and gender, because prematurity is the main risk factor for developing air leaks, especially for PIE, 23 and male gender has been associated with consistently worse pulmonary outcomes.…”

Section: Re Sultsmentioning

confidence: 99%

Preeclampsia was a risk factor for pulmonary interstitial emphysema in preterm infants born ≤32 weeks of gestational age

et al. 2020

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“…21 Recently, the oxygenation index at the time of diagnosis of PIE has been suggested to be the best predictor of the composite outcome of death or BPD. 23 Our case describes an unusual evolution of unilateral PIE after a period of clinical recovery in a neonate who initially required significant respiratory support, and in whom the PIE was treated successfully with positional therapy alone. At follow-up at 7 months, the infant was found to be symptom-free with a normal chest radiograph.…”

mentioning

confidence: 90%

“…Fatal PIE has been associated with bilaterality, lower birth weight, and higher peak inspiratory pressure 21 . Recently, the oxygenation index at the time of diagnosis of PIE has been suggested to be the best predictor of the composite outcome of death or BPD 23 …”

Section: Introductionmentioning

confidence: 99%

Unilateral neonatal pulmonary interstitial emphysema managed conservatively: A case report

Al-Mudares

Fernandes

2020

Pediatric Pulmonology

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Background Pulmonary interstitial emphysema (PIE) is a pathological state when air escapes from ruptured alveoli and is trapped along the sheaths surrounding the bronchovascular bundle. PIE is not uncommon in infants who require mechanical ventilation and even less common in infants on noninvasive ventilatory support; however, it is extremely unusual in infants in room air. Case Presentation A 2‐week‐old male infant developed worsening tachypnea in the special‐care nursery. The patient was born at 33 weeks' gestation by induced vaginal delivery due to pre‐eclampsia. He required positive pressure ventilation at birth and was admitted to the neonatal intensive care unit on nasal continuous positive airway pressure. On the second day of life, exogenous surfactant was administered via endotracheal tube due to increased oxygen requirement, and, soon after, he was weaned off all respiratory support. After 10 days of stability, he developed tachypnea with diminished air entry on the left side of the chest. Chest radiograph and chest computerized tomography confirmed left‐sided unilateral PIE. The patient was treated conservatively with positional therapy alone. Significant clinical and radiographic improvement was noticed within 4 days; almost complete resolution by 10 days and the infant was discharged 23 days later. At follow‐up at 7 months, the infant was found to be symptom‐free with a normal chest radiograph. Conclusions Traditional management of unilateral PIE generally involves a combination of invasive ventilatory support and positional therapy to break the vicious cycle pathophysiology of PIE. This report focuses on the insidious progression of PIE in nonventilated neonates and describes a nontraditional conservative management strategy for the management of unilateral PIE.

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Predictors of outcome of prematurely born infants with pulmonary interstitial emphysema

Abstract: Development of PIE was associated with poorer oxygenation and ventilation efficiency despite increased tidal volumes. The OI at PIE-worst predicted death or BPD.

Cited by 9 publications

References 17 publications

Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

Ventilation-to-perfusion relationships and right-to-left shunt during neonatal intensive care in infants with congenital diaphragmatic hernia

Preeclampsia was a risk factor for pulmonary interstitial emphysema in preterm infants born ≤32 weeks of gestational age

Unilateral neonatal pulmonary interstitial emphysema managed conservatively: A case report

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