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A Case of Pulmonary Interstitial Emphysema Treated by Percutaneous Catheter Insertion in Extremely Low Birth Weight
Changsin Kim1, Jeong Eun Shin1, Soon Min Lee2
1Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Percutaneous catheter insertion offers a viable treatment for premature infants with pulmonary interstitial emphysema (PIE). This minimally invasive approach may improve outcomes for extremely low birth weight (ELBW) neonates requiring mechanical ventilation.
Area of Science:
- Neonatology
- Pediatric Surgery
- Pulmonology
Background:
- Pulmonary interstitial emphysema (PIE) is a serious complication in premature infants on mechanical ventilation.
- Conservative management is common, but decompression is often necessary for severe cases.
Observation:
- A case of PIE in an extremely low birth weight (ELBW) infant (660 g, 23+2 weeks gestation) is presented.
- The infant developed PIE on day 12, and percutaneous catheter insertion was performed on day 25.
- Initial catheterization partially reduced PIE; subsequent interventions included catheter exchange and pleural space catheter insertion.
Findings:
- Percutaneous catheter insertion showed initial efficacy in reducing PIE size.
- Complications, including desaturation and pneumothorax, occurred but were managed with catheter adjustments.
- The infant was successfully weaned off ventilation after catheter removal.
Implications:
- Percutaneous catheter insertion represents a potentially effective and minimally invasive treatment option for PIE in ELBW infants.
- This technique may offer an alternative to surgical intervention in select cases.
- Further research is warranted to establish the role and optimal techniques for percutaneous catheterization in neonatal PIE.
Abstract:
The pulmonary interstitial emphysema (PIE) is a life-threatening illness in premature infants with mechanical ventilation. While most are managed conservatively, decompression would be necessary. Here, we report the first case of PIE treated by percutaneous catheter insertion in an extremely low birth weight (ELBW) infant in Korea. The patient, born with 660 g in 23+2 weeks of gestation, showed PIE in left lower lung on postnatal day 12. Percutaneous catheter insertion was performed on postnatal day 25. The size of PIE decreased, but didn't disappear completely. On postnatal day 42, we exchanged catheter and inserted additional catheter in pleural space. However, sudden desaturation and pneumothorax occurred on postnatal day 44. We changed catheter in pleural space, and pneumothorax and PIE improved. Finally, we successfully removed catheters, and weaned patient out. As in our case, percutaneous catheter insertion would be a useful option for ELBW infants with PIE.
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