[Bronchopleural fistula in a newborn: report of one case]

Persistent pneumothorax is infrequently seen in the neonate. Persistent pneumothorax with a large air leak and empyema may indicate the presence of a bronchopleural fistula which often results in mortality in infants requiring ventilator support. A ten-day-old female neonate with meconium aspiration syndrome was found to have respiratory distress after birth. During ventilator therapy, persistent pneumothorax with a large air leak from the chest tube was found. Empyema occurred three days later. Despite insertion of multiple chest tubes and use of bronchial balloon occlusion, a large air leak and empyema still were noted. Following thoracotomy and suture of the bronchopleural fistula, the air leak stopped. The patient was smoothly weaned from the ventilator. She was able to be discharged in good condition six weeks later. In management of the bronchopleural fistula, bronchial balloon occlusion enabled the patient to be maintained until more specific therapy could be attempted. Thoracotomy is definite therapy for selected infants requiring ventilator support who demonstrate a large air leak, persistent pneumothorax, and progressive hypoxia which is unresponsive to chest tube insertion.