Central nervous system air embolism in respiratory distress syndrome: considerations for patient survival

Neonatal pulmonary venous air embolism (arising as a consequence of ventilator therapy) remains at present an almost invariably fatal occurrence. We present a case that illustrates that it is possible for an infant to survive the immediate cardiovascular consequences of such an event; however, we demonstrate that embolic extension into the central nervous system (CNS) can occur as an associated sequela, and we offer the first published documentation (cranial ultrasonography) of this potentially pivotal complication. The temporal relationships between our patient's initial (but resolving) systemic embolism and his subsequent (and persistent) CNS event are documented and the implications discussed. Based on these observations, we caution that CNS involvement is difficult to recognize clinically and suggest that such involvement may contribute to a fatal outcome. Importantly, it appears that it may be possible to intervene in future cases to improve outcome, and we offer suggestions in this regard.