Pulmonary Interstitial Emphysema in a Full-Term Infant: Do We Know the Incidence?

Abstract

A Rejjal, Pulmonary Interstitial Emphysema in a Full-Term Infant: Do We Know the Incidence?. 2003; 23(3-4): 191-193 Pulmonary interstitial emphysema (PIE) occurs predominantly in premature infants exposed to mechanical ventilation. In the modern literature, pneumothorax is the most common form of air leak syndrome in full-term infants of average weight, while the incidence of PIE in the same age group is not known. We report a case of a fullterm infant who developed severe PIE secondary to aggressive conventional mechanical ventilation that responded to selective intubation and high frequency oscillatory ventilation. In addition, we review the incidence reported in the literature of PIE affecting full-term newborns. Case ReportA 3-day old full-term male infant, with a birth weight of 3.4 kilograms, was transferred from a district hospital because of deterioriation of respiratory function despite high mechanical ventilation requirements. The mother was a healthy, 35-year old (gravida 5, para 4) and a non-smoker. There was no maternal history to suggest infection. The family history was unremarkable. The infant was born by emergency cesarian delivery because of fetal distress and a thin meconium. The Apgar score was 6 at the first minute and 8 at the fifth minute. There was a minimal, thin meconium below the vocal cord on tracheal suctioning. The infant was showing signs of respiratory distress and was admitted to the neonatal intensive care for close monitoring.The infant's condition became worse and his FiO 2 requirement increased constantly with deterioration of arterial blood gas. He had to be intubated and conventional mechanical ventilation was initiated. A chest x-ray demonstrated a mild increase in bronchovascular markings, with no evidence of lung opacities. The infant's blood gas one hour after intubation was not improving and showed evidence of severe hypoxemia (PaO 2 of 30 mm Hg and PCO 2 of 42 mm Hg). Positive inspiratory pressure (PIP) was increased steadily until it was 37 cm H 2 O at 18 hours of age with anFiO 2 of 1 (100% oxygen) and a respiratory rate of 70per minute to maintain oxygen saturation between 85% to 90% on the monitor. At 24 hours of age, the ventilatory requirements increased and a chest x-ray showed evidence of diffuse pulmonary interstitial emphysema involving the whole left lung, complicatedshortly by tension pneumothorax that required chest tube insertion. On arrival at our NICU, the infant was extremely sick with unstable vital signs, an oxygen saturation of 80%, and severe metabolic and respiratory acidosis (pH of 7.1 and PaO 2 of 40 mm Hg, PCO 2 of 58 mm Hg and HCO 3 of 14 mm Hg). He was receiving mechanical ventilation with a PIP/PEEP (positive inspiratory and end-expiratory pressure) of 40/4 cm H 2 O, an inspiratory time of 0.7, and 100% oxygen. The infant was placed on high frequency oscillatory ventilation while inhaled nitric oxide was initiated 2 hours later at 20 parts per million as hypoxia persisted. Based on the severity of the emphysema and the unusual presenta...

Systemic Air Leak Syndrome in a Sick Full-Term Infant

“…Salama et al suggested that the incidence of air leak syndrome, particularly the pulmonary interstitial emphysema in full term infants, is vague. 4 Affected infants are usually premature and have severe respiratory insufficiency requiring a high ventilatory pressure. Lee et al reported that in 94% of cases, the air leaks would affect more than one anatomical site.…”