Systemic air embolism in a very-low-birth weight neonate treated with synthetic surfactant

Systemic air embolism is a rare but fatal complication of the ventilatory support. We reported a case with this complication after surfactant therapy. This 1175 gm neonate was born at the gestational age of 28 weeks. Endotracheal intubation was performed after birth for positive pressure ventilation. Surfactant therapies (Exosurf Neonatal) were given at two and fourteen hours of age. The ventilator settings were gradually weaned. Unfortunately, tachycardia, hypotension, pallor and O2 desaturation developed at thirty-nine hours of age. Many air bubbles were withdrawn from the arterial line. The chest radiography showed lucency in the heart and major vessels. The neonate died twenty-one hours later, despite aggressive resuscitation.