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Updated: Jul 2, 2026
International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure
Published on: March 12, 2020
Therapeutic lung puncture for diffuse unilateral pulmonary interstitial emphysema in preterm infants
M Dördelmann1, E Schirg, C F Poets
1Department of Neonatology, Hannover Medical School, Hannover, Germany. doerdelmann.michael@mh-hannover.de
Insights
A novel lung puncture technique successfully treated severe pulmonary interstitial emphysema (PIE) in premature infants. This intervention, creating a pneumothorax to release lung tension, offered a life-saving option when conventional treatments failed.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Pulmonary interstitial emphysema (PIE) is a serious complication of respiratory distress syndrome in premature infants.
- PIE significantly compromises lung ventilation and can lead to severe respiratory impairment.
Purpose of the Study:
- To describe a novel therapeutic approach for severe, diffuse, unilateral PIE in mechanically ventilated premature infants.
- To evaluate the efficacy of ipsilateral pneumothorax in infants unresponsive to conventional PIE management.
Main Methods:
- Case series of three premature infants with severe PIE.
- In two cases, spontaneous pneumothorax occurred; in the third, a pigtail catheter was used to create and drain an ipsilateral pneumothorax.
- All infants received mechanical ventilation prior to the intervention.
Main Results:
- All three infants experienced dramatic clinical improvement following the pneumothorax intervention.
- Mechanical ventilation was successfully discontinued within 3 days for all treated infants.
- The procedure involved creating and draining a pneumothorax to release tension in the overinflated lung.
Conclusions:
- Ipsilateral lung puncture to create and drain a pneumothorax is a viable therapeutic option for premature infants with severe PIE unresponsive to conservative measures.
- This minimally invasive approach may be considered as an alternative to surgery, potentially preserving functional lung tissue.
- Prompt tension release through pneumothorax drainage can significantly improve outcomes in PIE.
Background:
Pulmonary interstitial emphysema (PIE) represents a severe complication of respiratory distress syndrome and can dramatically impair the ventilation of premature infants.
Objectives:
We report three mechanically ventilated premature infants with severe diffuse, unilateral PIE not responding to conventional treatment, whose clinical condition improved dramatically following an ipsilateral pneumothorax.
Results:
In the first two patients, the pneumothoraces occurred spontaneously. In the third patient, the ipsilateral lung was punctured with a pigtail catheter to create and - subsequently drain - a pneumothorax. Thereafter, mechanical ventilation could be discontinued within 3 days in all infants.
Conclusions:
Lung puncture with consecutive tension release of the overinflated lung by drainage is a therapeutic option for premature infants suffering from diffuse PIE in whom other conservative measures fail. It may be considered before proceeding to surgical measures in order to preserve potentially functional lung tissue.
