Pneumatoceles in Infants in the Neonatal Intensive Care Unit: Clinical Characteristics and Outcomes

Abstract

Objective To describe the clinical characteristics and outcomes of neonatal intensive care unit patients with a radiographic diagnosis of pneumatocele.

Study Design Retrospective chart review.

Results Our cohort (n = 27) had a gestational age of 27 ± 5 weeks, birth weight of 1038 ± 760 g, and a predominance of females (59%) and black infants (74%). All infants were ventilated at the time of diagnosis at a median age of 12 days (range: 5 to 105 days). Endotracheal cultures sent from 25 infants revealed bacteria in 20 (80%). Clinical diagnosis of pneumonia was made in 18 (67%) infants. Pneumatoceles resolved in 17 (63%) infants, but persisted in 10 (37%) infants. Compared with infants with resolution of pneumatoceles, mortality (70% versus 0%, p < 0.001), positive endotracheal cultures (100% versus 67%, p = 0.05), and clinical diagnosis of pneumonia (100% versus 47%, p = 0.005) were significantly higher in infants with persistent pneumatoceles.

Conclusions In infants with pneumatoceles, positive endotracheal culture is a frequent finding and correlates with persistence. Persistence of pneumatoceles is associated with a higher mortality.

Keywords

endotracheal culture - pneumonia - persistent pneumatoceles - neonatal intensive care unit

• References

• 1 Quigley MJ, Fraser RS. Pulmonary pneumatocele: pathology and pathogenesis. AJR Am J Roentgenol 1988; 150: 1275-1277
• 2 Hussain N, Noce T, Sharma P , et al. Pneumatoceles in preterm infants—incidence and outcome in the post-surfactant era. J Perinatol 2010; 30: 330-336
• 3 Williams DW, Merten DF, Effmann EL, Scatliff JH. Ventilator-induced pulmonary pseudocysts in preterm neonates. AJR Am J Roentgenol 1988; 150: 885-887
• 4 Harris H. Pulmonary pseudocysts in the newborn infant. Pediatrics 1977; 59: 199-204
• 5 Clarke TA, Edwards DK. Pulmonary pseudocysts in newborn infants with respiratory distress syndrome. AJR Am J Roentgenol 1979; 133: 417-421
• 6 de Bie HM, van Toledo-Eppinga L, Verbeke JI, van Elburg RM. Neonatal pneumatocele as a complication of nasal continuous positive airway pressure. Arch Dis Child Fetal Neonatal Ed 2002; 86: F202-F203
• 7 Seo T, Ando H, Watanabe Y , et al. Acute respiratory failure associated with intrathoracic masses in neonates. J Pediatr Surg 1999; 34: 1633-1637
• 8 Baghdassarian OM, Weiner S. Pneumatocele formation complicating hydrocarbon pneumonitis. Am J Roentgenol Radium Ther Nucl Med 1965; 95: 104-111
• 9 Campbell JB. Pneumatocele formation following hydrocarbon ingestion. Am Rev Respir Dis 1970; 101: 414-418
• 10 Kuint J, Barzilai A, Regev-Yochay G, Rubinstein E, Keller N, Maayan-Metzger A. Comparison of community-acquired methicillin-resistant Staphylococcus aureus bacteremia to other staphylococcal species in a neonatal intensive care unit. Eur J Pediatr 2007; 166: 319-325
• 11 Bermejo Velasco E, González Molina E, Martinez Ayucar M , et al. [Pneumatocele as a complication of E. coli pneumonia in a newborn infant. Apropos of a case]. An Esp Pediatr 1992; 37: 526-528
• 12 Papageorgiou A, Bauer CR, Fletcher BD, Stern L. Klebsiella pneumonia with pneumatocele formation in a newborn infant. Can Med Assoc J 1973; 109: 1217-1219
• 13 Glustein JZ, Kaplan M. Enterobacter cloacae causing pneumatocele in a neonate. Acta Paediatr 1994; 83: 990-991
• 14 Purdy GD, Cullen M, Yedlin S, Bedard MP. An unusual neonatal case presentation: Streptococcus pneumoniae pneumonia with abscess and pneumatocele formation. J Perinatol 1987; 7: 378-381
• 15 Khan EA, Wafelman LS, Garcia-Prats JA, Taber LH. Serratia marcescens pneumonia, empyema and pneumatocele in a preterm neonate. Pediatr Infect Dis J 1997; 16: 1003-1005
• 16 Jackson CC, Bettolli M, De Carli C, Rubin S, Sweeney B. Thoracoscopic treatment of a neonatal traumatic pneumatocele. J Laparoendosc Adv Surg Tech A 2008; 18: 170-173
• 17 Fujii AM, Moulton S. VATS management of an enlarging multicystic pneumatocele. J Perinatol 2008; 28: 445-447