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Refractory Pulmonary Interstitial Emphysema in Extreme Premature Newborn
Mahmoud Ali1, Lea Mallett1, Greg Miller1
1Department of Pediatrics, Texas A&M Health Science Center, Baylor Scott & White McLane Children's Medical Center, Temple, Texas.
AJP Reports
|May 31, 2021
Summary
Pulmonary interstitial emphysema (PIE) in neonates can be challenging to manage. Selective right lung ventilation for two weeks successfully treated a premature infant with severe persistent PIE after other methods failed.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Critical Care Medicine
Background:
- Pulmonary interstitial emphysema (PIE) is a lung condition caused by air leakage into the interstitium, primarily affecting neonates with respiratory distress syndrome requiring positive pressure ventilation.
- While often associated with mechanical ventilation, PIE can also occur in spontaneously breathing infants.
Observation:
- This report details a case of an extremely low birth weight infant experiencing severe and persistent PIE.
- The infant required multiple forms of invasive mechanical ventilation, including high-frequency oscillatory ventilation, high-frequency jet ventilation, and neurally adjusted ventilatory assist.
Findings:
- Conventional treatments, such as brief periods of right mainstem intubation, were unsuccessful in managing the infant's condition.
- A prolonged 2-week trial of selective right lung ventilation proved to be a successful therapeutic strategy.
Implications:
- Selective lung ventilation can be an effective treatment for severe, persistent PIE in extremely low birth weight infants when conservative measures fail.
- This approach offers a potential alternative for managing complex respiratory complications in critically ill neonates.
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