Refractory Pulmonary Interstitial Emphysema in Extreme Premature Newborn

Ali, M. A.; Mallett, Lea; Miller, Greg A.

doi:10.1055/s-0041-1727261

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…This should be obtained with the affected side upward to observe for free air that is rising above the lung parenchyma. Pulmonary interstitial emphysema on radiography will appear as lacelike lucencies that are either in a linear pattern or will radiate from the pulmonary hilus to the edges of the lungs 17. Linear, oval, or spherical cystic areas will also be present.…”

Section: Recognition Of Air Leaksmentioning

confidence: 99%

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Management of Air Leaks in the Newborn

Kastein¹,

Coe²

2023

Advances in Neonatal Care

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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.

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Section: Recognition Of Air Leaksmentioning

confidence: 99%

“…Pulmonary interstitial emphysema on radiography will appear as lacelike lucencies that are either in a linear pattern or will radiate from the pulmonary hilus to the edges of the lungs. 17 Linear, oval, or spherical cystic areas will also be present. Areas of PIE can be localized or diffuse and can be in one or both lungs.…”

Section: Diagnosismentioning

confidence: 99%

Management of Air Leaks in the Newborn

Kastein¹,

Coe²

2023

Advances in Neonatal Care

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“…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). Other treatment methods that have been reported to successfully resolve PIE include lateral decubitus position, selective main bronchial intubation or occlusion, lung puncture, and lobectomy (7,(30)(31)(32)(33)(34)(35)(36). In our case report, we attempted conventional strategies such as the lateral decubitus position, gentle ventilation with shortened inspiratory time, reduced PIP, adjusted PEEP, HFOV with decreased MAP, and non-invasive ventilation.…”

Section: Discussionmentioning

confidence: 94%

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

Chen,

Chung,

Kang

et al. 2024

Front. Pediatr.

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Pulmonary interstitial emphysema (PIE) is a complication observed in extremely low birth weight (ELBW) infants on mechanical ventilation. Despite various proposed therapeutic interventions, the success rates have shown inconsistency. Neurally adjusted ventilatory assist (NAVA) stands out as a novel respiratory support mode, offering lower pressure and tidal volume in comparison to conventional ventilation methods. In this case report, we present five ELBW infants with refractory PIE who were transitioned to NAVA ventilation. Following the switch to NAVA, all cases of PIE gradually resolved. In contrast to traditional modes, NAVA provided respiratory support with significantly lower fraction of inspired oxygen, reduced peak inspiratory pressure, diminished mean airway pressure, and decreased tidal volume within 7 days of NAVA utilization (p = 0.042, 0.043, 0.043, and 0.042, respectively). Consequently, we propose that NAVA could serve as a valuable rescue treatment for ELBW infants with PIE.

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“Challenging acquired pulmonary interstitial emphysema in an extreme preterm infant: A case report and review of literature”

González López,

Lareu Vidal,

Álvarez Muñoz

et al. 2024

Journal of Neonatal-Perinatal Medicine

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Background Pulmonary interstitial emphysema (PIE) can occur in the immature lungs of preterm infants due to overdistension from mechanical ventilation. Case Report Preterm female infant (26 weeks of gestational age, 950 grams) born via urgent cesarean section, APGAR 1/3/6. Invasive mechanical ventilation during the first day of life transitioned to noninvasive positive pressure ventilation (NIPPV), afterward initially stable. Apnea and bradycardia noted at 20 days of life, requiring endotracheal intubation, with complementary studies showing right PIE. Progressive emphysema deterioration, air trapping, and left lung atelectasis, with hemodynamic repercussion despite positioning, high-frequency oscillatory ventilation, and hemodynamic support with dopamine and dobutamine. Selective left intubation attempted positioning the infant, unsuccessful. Due to failure of conventional therapies and impossibility to achieve selective intubation, pediatric surgery performed endobronchial balloon occlusion with angioplasty balloon inflated with contrast with fluoroscopy control. Progressive improvement, weaning ventilatory settings with acceptable oxygenation. Balloon was retired after 5 days. Mechanical ventilation was discontinued at 52 days of life. Infant was discharged without respiratory support nor oxygen at 100 days of life. Conclusions PIE treatment is based in conventional measures (respiratory support and positioning) but eventually might require alternative techniques when the first fail, with limited work in pediatric population and further technical limitations in the preterm infants.

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Refractory Pulmonary Interstitial Emphysema in Extreme Premature Newborn

Cited by 3 publications

References 28 publications

Management of Air Leaks in the Newborn

Management of Air Leaks in the Newborn

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

“Challenging acquired pulmonary interstitial emphysema in an extreme preterm infant: A case report and review of literature”

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