Clinical Improvements Following Posterior Cranial Vault Remodeling in a Patient With Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia (BPD) is a chronic lung disease and a known sequelae of prolonged mechanical ventilation in premature infants. Positive-end expiratory pressure (PEEP) can increase intracranial pressure, which can have devastating neurological effects. Intracranial hypertension is also associated with craniosynostosis: the premature fusion of cranial sutures, which can limit appropriate expansion of an infant's developing brain. We present the case of an ex-26-week, 18-month-old male with severe BPD, tracheobronchomalacia, tracheostomy dependence, and significant hemodynamic instability associated with BPD spells. A computed tomography of his head demonstrated coronal and sagittal craniosynostosis. Given his significant PEEP requirements, compounded with craniosynostosis, the craniofacial team recommended cranial vault expansion. Over 5 months following posterior cranial vault distraction, his required PEEP and morphine drip were successfully weaned. This case study evaluates the effects of ICP in the BPD patient population and discusses the potential benefits of cranial expansion in recalcitrant BPD patients.