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Pneumopericardium in very low birth weight infants
1Case Western Reserve University, Rainbow Babies and Childrens Hospital, Cleveland, OH 44106, USA.
Insights
Pneumopericardium (PPC) is rare in very low birth weight (VLBW) infants but has high mortality. Early detection in VLBW infants with worsening oxygenation is crucial for improved outcomes.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Pneumopericardium (PPC) is a rare but serious condition in neonates.
- Very low birth weight (VLBW) infants are particularly vulnerable to cardiorespiratory complications.
- Understanding the incidence and outcomes of PPC in VLBW infants is critical for clinical management.
Purpose of the Study:
- To determine the incidence of pneumopericardium in very low birth weight infants.
- To identify neonatal correlates associated with pneumopericardium.
- To describe the outcomes and neurodevelopmental status of VLBW infants with pneumopericardium.
Main Methods:
- Retrospective comparison of VLBW infants with PPC to a cohort of ventilated VLBW infants.
- Analysis of incidence rates, birth weight, gestational age, sex, and survival rates.
- Assessment of oxygenation index and neurodevelopmental outcomes at 20 months.
Main Results:
- PPC occurred in 2% of VLBW infants and 3.5% of ventilated VLBW infants.
- Male infants had a higher incidence of PPC.
- Survival rate for VLBW infants with PPC was 17%, significantly lower than the control group (60%).
- Survivors with PPC had a higher incidence of neurodevelopmental impairment (50%) compared to controls (35%).
Conclusions:
- Pneumopericardium is a rare condition in VLBW infants, associated with significant morbidity and mortality.
- A rising oxygenation index preceding acute deterioration may indicate PPC in VLBW infants.
- Prompt recognition and management are essential for improving outcomes in VLBW infants with pneumopericardium.
Abstract:
The objective of this study was to describe the incidence, neonatal correlates, and outcome of pneumopericardium (PPC) in very low birth weight (VLBW) < or = 1.5 kg infants. Forty-seven VLBW infants with a PPC, born during 1977 to 1989, were compared with a cohort of 1302 ventilated VLBW infants. PPC developed in 2% of 2389 VLBW infants and 3.5% of 1349 ventilated infants. The mean birth weight (1008 +/- 220 gm), and mean gestation (27 +/- 2 weeks) of the PPC cohort was similar to the control cohort. Thirty-two (68%) of the infants with PPC were male, compared with 691 (53%) of the ventilated infants (p < 0.05). Eight (17%) of the infants with PPC survived, compared with 780 (60%) of the control cohort (p < 0.00001). The oxygenation index significantly increased before PPC, and was significantly higher in nonsurvivors than survivors. Four (50%) of the PPC survivors had neurodevelopmental impairment at 20 months, compared with 35% of the control cohort. Pneumopericardium is a rare event with high morbidity and mortality. Clinicians should suspect this diagnosis in VLBW infants with a rising oxygenation index and subsequent acute deterioration.