Neonatal pneumopericardium: a surgical emergency

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Cardiology

Background:

• Pneumopericardium is a serious complication of mechanical ventilation in neonates with respiratory distress syndrome.
• It can lead to life-threatening cardiac tamponade.
• The incidence and management of pneumopericardium in this vulnerable population require careful study.

Purpose of the Study:

• To investigate the occurrence, clinical presentation, and outcomes of pneumopericardium in premature infants.
• To evaluate the effectiveness and complications of different treatment strategies for pneumopericardium.
• To identify factors contributing to recurrence and mortality.

Main Methods:

• Retrospective analysis of 47 premature infants with pneumopericardium between 1972 and 1981.
• Review of clinical data, ventilatory management (including positive end-expiratory pressure - PEEP), and associated conditions like pneumothorax.
• Assessment of outcomes for untreated and treated infants (pericardial aspiration, tube placement).

Main Results:

• Pneumopericardium occurred in 47 premature infants, often associated with PEEP ventilation.
• Hypotension, bradycardia, and hypoxia were common presenting symptoms in symptomatic infants.
• Treatment led to symptom resolution in 33 infants, but recurrence occurred in 13, with 5 deaths. Complications from tube placement caused 2 deaths.

Conclusions:

• Pneumopericardium is a significant complication of neonatal respiratory support, frequently associated with PEEP.
• While drainage procedures can resolve acute symptoms, recurrence and procedural complications pose substantial risks.
• Mortality remains high, underscoring the need for vigilant management and potentially improved preventative strategies.