Download PDF
CC BY-NC-ND 4.0 · AJP Rep 2018; 08(02): e99-e105
DOI: 10.1055/s-0038-1648253
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early Pulmonary Interstitial Emphysema in Preterm Neonates—Respiratory Management and Case Report in Nonventilated Very Low Birth Weight Twins

Judith Gronbach
1   Department of General and Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen, Germany
,
Harald Ehrhardt
1   Department of General and Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen, Germany
2   German Lung Research Center (DZL), Giessen, Germany
,
Klaus-Peter Zimmer
1   Department of General and Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen, Germany
,
Markus Waitz
1   Department of General and Neonatology, Center for Pediatrics and Youth Medicine, Justus Liebig University of Giessen, Germany
› Author Affiliations Funding Sources No external funding was secured for this article.
Further Information

Publication History

11 September 2017

20 March 2018

Publication Date:
14 May 2018 (online)

   Permissions and Reprints

Abstract

Early pulmonary interstitial emphysema in extreme preterm neonates is closely linked with respiratory distress syndrome and exposure to mechanical ventilation. In severe cases, maintaining adequate gas exchange aiming to avoid further lung damage and other neonatal morbidities associated with systemic/pulmonary hypoperfusion, prolonged hypoxia, and respiratory acidosis can be challenging and requires in-depth knowledge into the pathophysiology of the disease. Herein, we report on very low birth weight twins who developed early pulmonary interstitial emphysema during noninvasive respiratory support. We further review the current evidence from the literature, specifically addressing on possible preventive measures and the respiratory management options of this acute pulmonary disease in high-risk neonates.

Keywords

pulmonary interstitial emphysema - very-low-birth-weight infants - noninvasive ventilation - surfactant - antenatal steroids

Financial Disclosures

The authors have nothing to disclose.


 

  • References

  • 1 Hummler HD, Parys E, Mayer B, Essers J, Fuchs H, Schmid M. Risk indicators for air leaks in preterm infants exposed to restrictive use of endotracheal intubation. Neonatology 2015; 108 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 2 Wilson JM, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercise. Case 30–1997 - a preterm newborn female triplet with diffuse cystic changes in the left lung. N Engl J Med 1997; 337: 2103-2116
    PubMedGoogle Scholar
  • 3 Burnard ED, Gratton-Smith P, John E. A radiographic, pathologic and clinical study of interstitial emphysema complicating hyaline membrane disease. In: Stern L, Friss-Hansen B, Kildeberg P. , eds. Intensive Care in the Newborn. New York: Masson; 1976: 225-247
    Google Scholar
  • 4 Thibeault DW, Lachman RS, Laul VR, Kwong MS. Pulmonary interstitial emphysema, pneumomediastinum, and pneumothorax. Occurrence in the newborn infant. Am J Dis Child 1973; 126 (05) 611-614
    CrossrefPubMedGoogle Scholar
  • 5 Hart SM, McNair M, Gamsu HR, Price JF. Pulmonary interstitial emphysema in very low birthweight infants. Arch Dis Child 1983; 58 (08) 612-615
    CrossrefPubMedGoogle Scholar
  • 6 Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB. ; COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358 (07) 700-708
    CrossrefPubMedGoogle Scholar
  • 7 Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2012; 11: CD001456
    PubMedGoogle Scholar
  • 8 Peng W, Zhu H, Shi H, Liu E. Volume-targeted ventilation is more suitable than pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2014; 99 (02) F158-F165
    CrossrefPubMedGoogle Scholar
  • 9 Gürakan B, Tarcan A, Arda IS, Coşkun M. Persistent pulmonary interstitial emphysema in an unventilated neonate. Pediatr Pulmonol 2002; 34 (05) 409-411
    CrossrefPubMedGoogle Scholar
  • 10 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (07) 1723-1729
    CrossrefPubMedGoogle Scholar
  • 11 Morisot C, Kacet N, Bouchez MC. , et al. Risk factors for fatal pulmonary interstitial emphysema in neonates. Eur J Pediatr 1990; 149 (07) 493-495
    CrossrefPubMedGoogle Scholar
  • 12 Bawa P, Soontarapornchai K, Perenyi A, Goldfisher R, Amodio J. Development of localized pulmonary interstitial emphysema in a late preterm infant without mechanical ventilation. Case Rep Pediatr 2014; 2014 (14) 429797
    PubMedGoogle Scholar
  • 13 Al-Abdi SY, Singhal N. Pulmonary interstitial emphysema and continuous positive airway pressure in a premature infant. Saudi Med J 2005; 26 (10) 1627-1629
    PubMedGoogle Scholar
  • 14 Arioni C, Bellini C, Scopesi F, Mazzella M, Serra G. Pulmonary interstitial emphysema in preterm twins on continuous positive airway pressure. J Matern Fetal Neonatal Med 2006; 19 (10) 671-673
    CrossrefPubMedGoogle Scholar
  • 15 Ackerman Jr NB, Coalson JJ, Kuehl TJ. , et al. Pulmonary interstitial emphysema in the premature baboon with hyaline membrane disease. Crit Care Med 1984; 12 (06) 512-516
    CrossrefPubMedGoogle Scholar
  • 16 Reynolds EO, Roberton NR, Wigglesworth JS. Hyaline membrane disease, respiratory distress, and surfactant deficiency. Pediatrics 1968; 42 (05) 758-768
    PubMedGoogle Scholar
  • 17 Rojas MA, Lozano JM, Rojas MX. , et al; Colombian Neonatal Research Network. Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure: a randomized, controlled trial. Pediatrics 2009; 123 (01) 137-142
    CrossrefPubMedGoogle Scholar
  • 18 Finer NN, Carlo WA, Walsh MC. , et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010; 362 (21) 1970-1979
    CrossrefPubMedGoogle Scholar
  • 19 Sandri F, Plavka R, Ancora G. , et al; CURPAP Study Group. Prophylactic or early selective surfactant combined with nCPAP in very preterm infants. Pediatrics 2010; 125 (06) e1402-e1409
    CrossrefPubMedGoogle Scholar
  • 20 Stevens TP, Harrington EW, Blennow M, Soll RF. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 2007; 4 (04) CD003063
    PubMedGoogle Scholar
  • 21 Aldana-Aguirre JC, Pinto M, Featherstone RM, Kumar M. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2017; 102 (01) F17-F23
    CrossrefPubMedGoogle Scholar
  • 22 Kribs A, Roll C, Göpel W. , et al; NINSAPP Trial Investigators. Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 2015; 169 (08) 723-730
    CrossrefPubMedGoogle Scholar
  • 23 Silverman WA, Andersen DH. A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics 1956; 17 (01) 1-10
    PubMedGoogle Scholar
  • 24 O'Donovan D, Wearden M, Adams J. Unilateral pulmonary interstitial emphysema following pneumonia in a preterm infant successfully treated with prolonged selective bronchial intubation. Am J Perinatol 1999; 16 (07) 327-331
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Fujimura M, Kitajima H, Nakayama M. Increased leukocyte elastase of the tracheal aspirate at birth and neonatal pulmonary emphysema. Pediatrics 1993; 92 (04) 564-569
    CrossrefPubMedGoogle Scholar
  • 26 Verma RP, Chandra S, Niwas R, Komaroff E. Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants. J Perinatol 2006; 26 (03) 197-200
    CrossrefPubMedGoogle Scholar
  • 27 Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017; 3: CD004454
    PubMedGoogle Scholar
  • 28 Waters TP, Mercer B. Impact of timing of antenatal corticosteroid exposure on neonatal outcomes. J Matern Fetal Neonatal Med 2009; 22 (04) 311-314
    CrossrefPubMedGoogle Scholar
  • 29 McEvoy C, Schilling D, Spitale P, Peters D, O'Malley J, Durand M. Decreased respiratory compliance in infants less than or equal to 32 weeks' gestation, delivered more than 7 days after antenatal steroid therapy. Pediatrics 2008; 121 (05) e1032-e1038
    CrossrefPubMedGoogle Scholar
  • 30 Peltoniemi OM, Kari MA, Tammela O. , et al; Repeat Antenatal Betamethasone Study Group. Randomized trial of a single repeat dose of prenatal betamethasone treatment in imminent preterm birth. Pediatrics 2007; 119 (02) 290-298
    CrossrefPubMedGoogle Scholar
  • 31 Crowther CA, McKinlay CJ, Middleton P, Harding JE. Repeat doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes. Cochrane Database Syst Rev 2015; 5 (07) CD003935
    PubMedGoogle Scholar
  • 32 Meadow WL, Cheromcha D. Successful therapy of unilateral pulmonary emphysema: mechanical ventilation with extremely short inspiratory time. Am J Perinatol 1985; 2 (03) 194-197
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Ng KP, Easa D. Management of interstitial emphysema by high-frequency low positive-pressure hand ventilation in the neonate. J Pediatr 1979; 95 (01) 117-118
    CrossrefPubMedGoogle Scholar
  • 34 Gortner L, Pohlandt F, Bartmann P. [Treatment of unilateral space-occupying pulmonary interstitial emphysema with positioning measures and high-frequency ventilation] [Article in German]. Monatsschr Kinderheilkd 1988; 136 (08) 432-435
    PubMedGoogle Scholar
  • 35 Frantz III ID, Werthammer J, Stark AR. High-frequency ventilation in premature infants with lung disease: adequate gas exchange at low tracheal pressure. Pediatrics 1983; 71 (04) 483-488
    PubMedGoogle Scholar
  • 36 Squires KA, De Paoli AG, Williams C, Dargaville PA. High-frequency oscillatory ventilation with low oscillatory frequency in pulmonary interstitial emphysema. Neonatology 2013; 104 (04) 243-249
    CrossrefPubMedGoogle Scholar
  • 37 Carlo WA, Siner B, Chatburn RL, Robertson S, Martin RJ. Early randomized intervention with high-frequency jet ventilation in respiratory distress syndrome. J Pediatr 1990; 117 (05) 765-770
    CrossrefPubMedGoogle Scholar
  • 38 Keszler M, Donn SM, Bucciarelli RL. , et al. Multicenter controlled trial comparing high-frequency jet ventilation and conventional mechanical ventilation in newborn infants with pulmonary interstitial emphysema. J Pediatr 1991; 119 (1 Pt 1): 85-93
    CrossrefPubMedGoogle Scholar
  • 39 Chalak LF, Kaiser JR, Arrington RW. Resolution of pulmonary interstitial emphysema following selective left main stem intubation in a premature newborn: an old procedure revisited. Paediatr Anaesth 2007; 17 (02) 183-186
    CrossrefPubMedGoogle Scholar
  • 40 Milligan DW, Issler H, Massam M, Reynolds EO. Treatment of neonatal pulmonary interstitial emphysema by lung puncture. Lancet 1984; 1 (8384): 1010-1011
    PubMedGoogle Scholar
  • 41 Rastogi S, Gupta A, Wung JT, Berdon WE. Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan-Ganz catheter. Pediatr Radiol 2007; 37 (11) 1130-1134
    CrossrefPubMedGoogle Scholar