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Pulmonary interstitial emphysema in very low birthweight infants
Insights
Pulmonary interstitial emphysema (PIE) affects vulnerable newborns, especially those under 1000g. Ventilation for hyaline membrane disease significantly increases PIE risk and mortality in infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Medical Imaging
Background:
- Pulmonary interstitial emphysema (PIE) is a serious complication in neonates.
- Premature infants, particularly those with low birth weight, are at higher risk.
- Understanding risk factors and associations is crucial for early intervention.
Purpose of the Study:
- To investigate the incidence and risk factors of pulmonary interstitial emphysema (PIE) in infants weighing less than 1500 g.
- To determine the association between ventilation for hyaline membrane disease and PIE development.
- To analyze the relationship between PIE and pneumothorax, and its impact on mortality.
Main Methods:
- Retrospective analysis of chest radiographs from 142 infants weighing <1500 g within the first 5 days of life.
- Categorization of infants based on birth weight (<1000 g vs. 1000-1500 g).
- Correlation of PIE development with clinical factors such as ventilation and hyaline membrane disease.
Main Results:
- 46 out of 142 infants developed PIE, with 19 cases in the first 24 hours.
- PIE was more prevalent in infants <1000 g (24/57) compared to those 1000-1500 g (22/85).
- Ventilation for hyaline membrane disease showed a strong association with PIE; only treated infants developed PIE. Most pneumothoraces (17/21) were preceded by PIE. Mortality was higher in ventilated infants with PIE.
Conclusions:
- Infants weighing less than 1500 g are susceptible to PIE, especially those requiring ventilation for hyaline membrane disease.
- Early recognition of PIE on chest radiographs is critical, as it often precedes pneumothorax.
- PIE is associated with increased mortality in ventilated neonates, highlighting the need for vigilant monitoring and management.
Abstract:
Forty six of 142 infants weighing less than 1500 g at birth, who had chest radiographs in the first 5 days of life, developed pulmonary interstitial emphysema (PIE) and in 19 this occurred in the first 24 hours. PIE was seen more frequently in infants weighing less than 1000 g at birth (24 of 57) than in those weighing 1000-1500 g (22 of 85). Ventilation for hyaline membrane disease was strongly associated with PIE, and only babies who were resuscitated, or ventilated, or had hyaline membrane disease developed the disorder. Most pneumothoraces were preceded by x-ray appearances of PIE (17 of 21). Mortality was increased in ventilated infants who developed PIE and was high in those with severe x-ray changes.