Stepwise multidisciplinary approach in very low birthweight infant with bronchopleural fistula
Anna Milan1, Iain Yardley2,3, Grenville Fox4
1Neonatology, Evelina London Children's Hospital, London, UK anna.milan@gstt.nhs.uk.
Insights
A rare bronchopleural fistula in a premature infant was successfully repaired with bedside surgery. This multidisciplinary approach highlights early surgical team involvement for critical neonatal cases.
Area of Science:
- Neonatal Surgery
- Pediatric Thoracic Surgery
- Critical Care Medicine
Background:
- Premature infants face unique challenges, including respiratory complications like pneumothorax.
- Bronchopleural fistula (BPF) is a rare but life-threatening condition in neonates, often associated with high mortality.
- Septic shock and tension pneumothorax further complicate management in very low birthweight infants.
Observation:
- A 25-week gestation infant presented with chest infection, septic shock, and tension pneumothorax.
- Despite conventional treatments, including chest drains and pleurodesis, lung re-inflation was unsuccessful, indicating a likely bronchopleural fistula.
- A large tear at the carina extending into the left main bronchus was identified.
Findings:
- A stepwise, multidisciplinary approach was implemented, involving parents and surgical teams.
- Bedside open chest surgery was performed during a window of stability.
- Successful surgical repair of the bronchopleural fistula led to immediate clinical improvement.
Implications:
- This case demonstrates the feasibility and success of cot-side surgical intervention for complex neonatal bronchopleural fistulas.
- Early involvement of pediatric general and cardiothoracic surgical teams is crucial for optimal outcomes.
- A multidisciplinary strategy is vital for managing life-threatening respiratory emergencies in extremely premature infants.
Abstract:
A 25-week gestation infant experienced chest infection complicated by septic shock and tension pneumothorax. Despite multiple drains, it was impossible to reinflate the lung, thus suggesting a bronchopleural fistula. Multidisciplinary meetings were arranged, involving the parents, and a stepwise approach was agreed. Chest drain repositioning, single lung ventilation and pleurodesis proved unsuccessful. In a rare window of relative stability, open chest surgery was performed at the cot-side by the paediatric general and cardiothoracic surgical teams. A large tear was identified at the carina, extending along the left main bronchus. This was repaired, with immediate clinical improvement. He was extubated 7 days later and discharged home on day 94 (CGA 39+0). This case report describes a successful stepwise multidisciplinary approach to a bronchopleural fistula in a very low birthweight infant, highlighting the potential for surgical intervention at cot-side and the value of involving the surgical team early on.
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