Surgical management of neonatal interstitial emphysema

In the past 6 years, 50 patients with interstitial emphysema in our newborn nursery were treated with open operative procedures to remove interstitial air. Thirty-one were critically ill newborns with severe progressive pulmonary interstitial emphysema treated with pleurotomies. Five underwent pleurotomies on both sides, for a total of 36 operations in the 31 patients. All of the 31 patients underwent aggressive medical management to reduce airway pressure before resorting to operation. Ventilator manipulations, selective bronchial intubation, Forgerty catheter occlusion of the bronchus, and percutaneous lung needling were among the methods used to reduce emphysema in these patients. The operation for all 31 patients consisted of multiple linear pleurotomies to lyse blebs. The hilum was skeletonized to release perihilar blebs. A downhill course was reversed by the operation in over 50% of patients. The operation almost always permanently cured the tension emphysema on that side. Seventeen of the 31 patients lived. Eight of ten patients with unilateral disease lived. All of those patients who died had either very low birth weight, severe preoperative hypoxia, shock, or a combination of these problems.