Unilateral neonatal pulmonary interstitial emphysema managed conservatively: A case report

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• Pulmonary interstitial emphysema (PIE) is characterized by air trapping around bronchovascular bundles, typically seen in mechanically ventilated infants.
• While uncommon in infants on noninvasive support, PIE in neonates breathing room air is exceptionally rare.

Observation:

• A 2-week-old premature infant, initially requiring respiratory support, developed unilateral PIE after surfactant administration and weaning.
• Clinical presentation included worsening tachypnea and diminished breath sounds on the left side of the chest.

Findings:

• Chest imaging confirmed left-sided unilateral PIE.
• Conservative management with positional therapy alone led to rapid clinical and radiographic improvement within days.
• The infant achieved complete resolution and remained symptom-free at 7-month follow-up.

Implications:

• This case suggests that conservative management, including positional therapy, can be effective for unilateral PIE in non-ventilated neonates.
• It challenges traditional approaches that often involve invasive ventilation.
• Highlights the potential for non-traditional, conservative strategies in managing rare neonatal respiratory conditions.