Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature
Abstract Background Pulmonary interstitial emphysema (PIE) in very low birth weight infants is a rare but severe complication. Although most of these air leaks develop in mechanically ventilated infants, they have also been reported in infants exposed only to nasal continuous positive airway pressur...
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doaj-58d353fc5d104d8986fef0ce0253a5b72020-11-25T01:23:22ZengBMCBMC Pediatrics1471-24312019-08-011911510.1186/s12887-019-1640-2Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literatureXiaoping Lei0Oliver Stangl1Christina Bösche2Kristina Stuchlik3Roland Czorba4Christian Wieg5Department of Neonatology, Affiliated Hospital of Southwest Medical UniversityDepartment of Neonatology and Pediatric Intensive CareDepartment of Neonatology and Pediatric Intensive CareDepartment of Neonatology and Pediatric Intensive CareDepartment of Gynecology and Obstetrics, Klinikum AschaffenburgDepartment of Neonatology and Pediatric Intensive CareAbstract Background Pulmonary interstitial emphysema (PIE) in very low birth weight infants is a rare but severe complication. Although most of these air leaks develop in mechanically ventilated infants, they have also been reported in infants exposed only to nasal continuous positive airway pressure (CPAP). The optimal treatment for PIE is still under discussion and includes different approaches such as unilateral intubation, high frequency oscillation ventilation and even surgical lobectomy. However, as yet, there has been no report on complete resolution of unilateral PIE by positioning therapy without mechanical ventilation. Case presentation We report the case of a 28+1gestational week twin, 990 g birth weight, Apgar 9–10-10. After stabilization with nasal CPAP the baby received surfactant by less invasive surfactant application (LISA) technique in the delivery room after 35 min of life, and continued respiratory support with nasal CPAP. At day 5 X-ray presented unilateral PIE, while pCO2 increased from 40 mmHg to 55 mmHg and FiO2 from 0.21 to 0.28 to achieve SpO2 in the target range of 89–94%. The baby was treated by strict positioning on the affected hemithorax in a special splint while spontaneously breathing on High Flow Nasal Cannula (HFNC). Complete resolution of the unilateral PIE was observed after 96 h. No chronic lung disease developed. Conclusion For unilateral PIE in very preterm infants, positioning on the affected hemithorax without mechanical ventilation is a therapeutic option.http://link.springer.com/article/10.1186/s12887-019-1640-2Pulmonary interstitial emphysemaNon-invasive treatmentPrematurity |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Xiaoping Lei Oliver Stangl Christina Bösche Kristina Stuchlik Roland Czorba Christian Wieg |
spellingShingle |
Xiaoping Lei Oliver Stangl Christina Bösche Kristina Stuchlik Roland Czorba Christian Wieg Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature BMC Pediatrics Pulmonary interstitial emphysema Non-invasive treatment Prematurity |
author_facet |
Xiaoping Lei Oliver Stangl Christina Bösche Kristina Stuchlik Roland Czorba Christian Wieg |
author_sort |
Xiaoping Lei |
title |
Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature |
title_short |
Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature |
title_full |
Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature |
title_fullStr |
Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature |
title_full_unstemmed |
Positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature |
title_sort |
positional treatment without mechanical ventilation in a very preterm infant with unilateral pulmonary interstitial emphysema: case report and review of the literature |
publisher |
BMC |
series |
BMC Pediatrics |
issn |
1471-2431 |
publishDate |
2019-08-01 |
description |
Abstract Background Pulmonary interstitial emphysema (PIE) in very low birth weight infants is a rare but severe complication. Although most of these air leaks develop in mechanically ventilated infants, they have also been reported in infants exposed only to nasal continuous positive airway pressure (CPAP). The optimal treatment for PIE is still under discussion and includes different approaches such as unilateral intubation, high frequency oscillation ventilation and even surgical lobectomy. However, as yet, there has been no report on complete resolution of unilateral PIE by positioning therapy without mechanical ventilation. Case presentation We report the case of a 28+1gestational week twin, 990 g birth weight, Apgar 9–10-10. After stabilization with nasal CPAP the baby received surfactant by less invasive surfactant application (LISA) technique in the delivery room after 35 min of life, and continued respiratory support with nasal CPAP. At day 5 X-ray presented unilateral PIE, while pCO2 increased from 40 mmHg to 55 mmHg and FiO2 from 0.21 to 0.28 to achieve SpO2 in the target range of 89–94%. The baby was treated by strict positioning on the affected hemithorax in a special splint while spontaneously breathing on High Flow Nasal Cannula (HFNC). Complete resolution of the unilateral PIE was observed after 96 h. No chronic lung disease developed. Conclusion For unilateral PIE in very preterm infants, positioning on the affected hemithorax without mechanical ventilation is a therapeutic option. |
topic |
Pulmonary interstitial emphysema Non-invasive treatment Prematurity |
url |
http://link.springer.com/article/10.1186/s12887-019-1640-2 |
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