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Subatmospheric oxygen therapy complicating subcutaneous emphysema

D A Dodd¹, J A Johns, W F Walsh

¹Division of Pediatric Cardiology, D-2220 MCN, Vanderbilt University Medical Center, Nashville, TN 37232, USA.

Pediatric Cardiology

|August 14, 1998

Summary

Subatmospheric oxygen therapy stabilized an infant with hypoplastic left heart syndrome. Unexpected subcutaneous emphysema developed but resolved spontaneously, allowing for successful heart transplantation.

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Area of Science:

Pediatric Cardiology
Neonatology
Cardiovascular Surgery

Background:

Hypoplastic left heart syndrome (HLHS) is a complex congenital heart defect characterized by underdevelopment of the left side of the heart.
Infants with HLHS often present with excessive pulmonary blood flow and tachypnea, requiring immediate medical intervention.
Management strategies aim to balance pulmonary and systemic blood flow to improve cardiorespiratory status.

Observation:

A neonate diagnosed with HLHS, excessive pulmonary blood flow, and tachypnea was treated with subatmospheric oxygen (supplemental nitrogen).
This intervention aimed to increase pulmonary vascular resistance and reduce pulmonary blood flow, stabilizing the infant's condition without mechanical ventilation.
Two weeks post-initiation of therapy, the infant developed spontaneous subcutaneous emphysema, which progressively worsened over a month.

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Findings:

During the period of emphysema development, the infant's left-to-right shunt decreased, and he was successfully weaned to room air.
The subcutaneous emphysema resolved completely without any complications, even after discontinuing supplemental oxygen.
The patient subsequently underwent a successful orthotopic heart transplantation at 65 days of age.

Implications:

Subatmospheric oxygen therapy may be a viable temporizing measure for neonates with HLHS and excessive pulmonary blood flow.
The development of subcutaneous emphysema, while concerning, appears to be a transient and self-limiting complication in this context.
This case highlights the complex interplay between congenital heart defects, therapeutic interventions, and potential iatrogenic complications in neonates.