Dry lung syndrome: complete airway collapse mimicking pulmonary hypoplasia?

We observed a premature baby born after severe oligohydramnios who could not be ventilated efficiently even with very high pressures immediately after birth, but who, after cessation of resuscitation attempts, recovered spontaneous sufficient breathing during the following hour. After this experience we searched our case records for other newborns with dry lung syndrome using the following definition: (1) premature birth after prolonged leakage of amniotic fluid, (2) very high ventilatory requirement after birth, (3) dramatic improvement during the first 24 to 36 h and (4) respiratory distress syndrome and infection excluded. Among 93 prematures with rupture of membranes for 4 days or more we found 3, including the index case, matching this definition.

Dry lung syndrome appears to be a distinct clinical entity that is possibly underrecognised but recognisable and that merits further study. Its pathogenesis may imply complete collapse of small airways to a degree that capillary forces impede distension by ordinary ventilatory pressures.