Risk factors for fatal pulmonary interstitial emphysema in neonates

Abstract

Among 315 infants treated for respiratory distress syndrome (RDS) over a 2 year period, 32 prematures were studied retrospectively with the diagnosis of pulmonary interstitial emphysema (PIE). Eighteen died. In this group, birth weight below 1600 g, need for oxygen above 0.6 on the 1st day and appearance of bilateral pulmonary interstitial emphysema within the first 48 h of life were significant risk factors, with a mortality rate of 94%. In order to recognize one or more early criteria predictive of fatal PIE, we compared ventilation parameters on day 1 between neonates with fatal PIE and those with the same birth weight and initial severity of RDS but without PIE treated during the same period. High positive inspiratory pressure on day 1 was found to be the most significant parameter associated with further appearance of fatal pulmonary interstitial emphysema. A cut-off level of 26 cm H2O was found to be discriminant. These criteria may be useful in selecting those neonates who might best benefit from a new therapy such as high frequency ventilation, before irreversible lesions appear.

Management of Pulmonary Interstitial Emphysema in a Premature Infant using Nasopharyngeal High-Frequency Oscillatory Ventilation

“…Even during minimal pressure ventilation [2], PIE may complicate invasive mechanical ventilation very early in the life of VLBW infants [4] with underdeveloped lungs.…”

“…The increased distance between the pulmonary vascular bed and airspaces reduces gas exchange. The heart tends to get smaller as intrathoracic pressure increases, resulting in a diminished venous return and cardiac output [4].…”

One-Sided High-Frequency Oscillatory Ventilation in the Management of an Acquired Neonatal Lobar Emphysema. A Case Report and Review

“…Known forms of air leak are pneumothorax, pneumomediastinum, pulmonary interstitial emphysema (PIE), and left-sided acquired lobar emphysema (ALPE). 3,4 The therapeutic management of ALPE is difficult and not always successful. Therapeutic options include positioning of the neonate on the affected hemithorax, 5,6 selective ventilation of the nonaffected lung with conventional ventilation (CV), 7 selective occlusion of the affected mainstem bronchus, 8 ± 11 surgical resection of the affected lung portion, 12,13 application of high-frequency ventilation (HFV) to the trachea, 14 and administration of dexamethasone.…”

Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants

“…PIE is diagnosed radiologically [4,5] and characterised by the presence of linear radiolucencies reflecting an accumulation of interstitial air. This may result in impaired pulmonary blood flow, decreased lung compliance and in-creased airway resistance [6,7]. The mortality of infants with PIE that were managed with conventional mechanical ventilation in the pre-surfactant 1980s was reported to be as high as 67% [8] and 80% [6].…”

“…This may result in impaired pulmonary blood flow, decreased lung compliance and in-creased airway resistance [6,7]. The mortality of infants with PIE that were managed with conventional mechanical ventilation in the pre-surfactant 1980s was reported to be as high as 67% [8] and 80% [6]. Infants with PIE who are at greatest risk of dying are those of very low birthweight (!1,500 g) who receive high peak inspiratory pressures (125 cm H 2 O) during the first 24 h of life [9].…”