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Extubation failure due to phrenic nerve injury
O Williams1, A Greenough, N Mustfa
1Children Nationwide Regional Neonatal Intensive Care Centre, King's College Hospital, London SE5 9RS, UK.
Archives of Disease in Childhood. Fetal and Neonatal Edition
|December 24, 2002
Summary
Phrenic nerve injury in a premature infant, caused by chest tube insertion for pleural effusions, led to diaphragm dysfunction. Surgical repair with diaphragmatic plication successfully restored function, enabling extubation.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Respiratory Physiology
Background:
- Premature infants often require interventions like chest tube drainage for conditions such as pleural effusions.
- Diaphragmatic dysfunction can arise from various causes, including iatrogenic injury, complicating respiratory management.
- Failed extubation is a significant concern in neonatal intensive care, often indicating underlying respiratory compromise.
Observation:
- A 26-week gestation infant presented with progressive right hemidiaphragm elevation after bilateral pleural effusion drainage.
- Repeated extubation attempts were unsuccessful, prompting further investigation into respiratory mechanics.
- Electrical stimulation confirmed absent right phrenic nerve activity, strongly suggesting injury secondary to chest tube placement.
Findings:
- The infant's symptoms were attributed to iatrogenic phrenic nerve injury, a complication of chest tube drain insertion.
- Diaphragmatic plication, a surgical procedure to correct diaphragm elevation, was performed.
- Following diaphragmatic plication, the infant demonstrated improved respiratory function.
Implications:
- Diaphragmatic plication can be an effective treatment for phrenic nerve injury-induced diaphragmatic paralysis in neonates.
- Prompt diagnosis and surgical intervention are crucial for improving respiratory outcomes in affected infants.
- This case highlights the importance of recognizing and managing phrenic nerve injury as a potential complication of thoracic procedures in premature infants.