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Pulmonary interstitial emphysema in infants less than 1000 g at birth
Insights
Pulmonary interstitial emphysema (PIE) affects 32% of very low birthweight infants, particularly those born under 1000g. This condition remains a significant cause of mortality and morbidity in neonates, necessitating preventative strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Pulmonary interstitial emphysema (PIE) is a serious complication in extremely low birthweight infants.
- The incidence and outcomes associated with PIE have been a concern for decades.
- Understanding PIE's impact on neonatal mortality and morbidity is crucial.
Purpose of the Study:
- To determine the incidence of PIE in infants weighing less than 1000g.
- To analyze trends in PIE incidence and mortality over an eight-year period.
- To assess the association between PIE and other air leak syndromes.
Main Methods:
- Retrospective analysis of 249 infants weighing less than 1000g.
- Data collection on PIE development, timing, and associated conditions.
- Comparison of mortality rates in infants with and without PIE across different study periods.
Main Results:
- 32% of infants (80/249) developed PIE, with higher incidence in lower birthweight groups (500-799g: 42%).
- 55% of PIE cases occurred within the first 24 hours of life; 43% were linked to other air leaks.
- Mortality associated with PIE did not improve between 1977-1984, and became significantly higher in infants with PIE compared to those without in the latter half of the study.
Conclusions:
- Pulmonary interstitial emphysema remains a significant contributor to mortality and morbidity in extremely low birthweight infants.
- There has been no improvement in PIE incidence or mortality rates over the study period.
- Effective prevention strategies for PIE are essential to improve outcomes for this vulnerable population.
Abstract:
Eighty (32%) of 249 infants weighing less than 1000 g at birth developed pulmonary interstitial emphysema (PIE); its incidence was 42% in infants at 500-799 g, 29% at 800-899 g and 20% at 900-999 g. Fifty-five per cent occurred in the first 24 h and 43% were associated with other forms of air leak. The incidence and mortality of PIE did not improve between 1977 and 1984. The mortality rates in infants with or without PIE were not significantly different in the first 4 years of the study period (53% vs 45%). As the mortality improved in infants without PIE during the second 4 years, the difference in mortality rates in infants with or without PIE became significant (68% vs 29%). PIE continues to be associated with serious mortality and morbidity in extremely low birthweight infants. Effective measures to prevent PIE are required before further improvement in their outcome can be achieved.