Abstract
Among 315 infants treated for respiratory distress syndrome (RDS) over a 2 year period, 32 prematures were studied retrospectively with the diagnosis of pulmonary interstitial emphysema (PIE). Eighteen died. In this group, birth weight below 1600 g, need for oxygen above 0.6 on the 1st day and appearance of bilateral pulmonary interstitial emphysema within the first 48h of life were significant risk factors, with a mortality rate of 94%. In order to recognize one or more early criteria predictive of fatal PIE, we compared ventilation parameters on day 1 between neonates with fatal PIE and those with the same birth weight and initial severity of RDS but without PIE treated during the same period. High positive inspiratory pressure on day 1 was found to be the most significant parameter associated with further appearance of fatal pulmonary interstitial emphysema. A cut-off level of 26 cm H2O was found to be discriminant. These criteria may be useful in selecting those neonates who might best benefit from a new therapy such as high frequency ventilation, before irreversible lesions appear.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Abbreviations
- FiO2 :
-
oxygen concentration in inspired air
- HFV:
-
high frequency ventilation
- I/E:
-
inspiratory-expiratory ratio
- PaCO2 :
-
CO2 pressure in arteial blood
- PaO2 :
-
oxygen pressure in arterial blood
- PEEP:
-
postive end expiratory pressure
- PIE:
-
pulmonary interstitial emphysema
- PIP:
-
peak inspiratory pressure
- RDS:
-
respiratory distress syndrome
References
Bartlett RH, Andrews AF, Toomasian JM (1982) Extracorporeal membrane oxygenation for newborn respiratory failure: forty five cases. Surgery 92:425–433
Campbell RE (1970) Intrapulmonary interstitial emphysema: a complication of hyaline membrane disease. AJR 110:449–456
Chang HK, Harf A (1984) High frequency ventilation: a review. Respir Physiol 57:135–152
Dear PRF, Conway SP (1984) Treatment of severe bilateral interstitial emphysema in a baby by artificial pneumothorax and pneumotomy. Lancet I:273–275
De Blic J, Scheinmann P, Paupe J (1984) Successful treatment of persistent neonatal intersititial emphysema by flexible bronchoscopy. Lancet II:1389–1390
Frantz ID, Werthammer J, Stark AR (1983) High frequency ventilation in premature infants with lung disease: adequate gas exchange at low tracheal pressure. Pediatrics 71:483–488
Gaylord MS, Quissel BJ, Lair ME (1987) High frequency ventilation in the treatment of infants weighing less than 1,500 grams with pulmonary interstitial emphysema: a pilot study. Pediatrics 79:915–921
Gaylord MS, Thieme RE, Woodall DL, Quissel BJ (1985) Predicting mortality in low birth weight infants with pulmonary interstitial emphysema. Pediatrics 76:219–224
Greenough A, Dixon AK, Roberton NRC (1984) Pulmonary interstitial emphysema. Arch Dis Child 59:1046–1051
Gregoire R, Yulish B, Martin R, Fletcher B, Fanaroff A (1977) Natural history of pulmonary interstitial emphysema in the preterm infant. Pediatr Res 13:1019A
Harris TR, Christensen RD (1984) High frequency jet ventilation treatment of pulmonary interstitial emphysema. Pediatr Res 18: 326A
Hart SM, Mc Nair M, Gamsu HR, Price JF (1983) Pulmonary interstitial emphysema in very low birth weight infants. Arch Dis Child 58:612–615
Heneghan MA, Sosulski R, Alarcon MB (1987) Early pulmonary interstitial emphysema in the newborn: a grave prognostic sign. Clin Pediatr 26:361–365
Milligan DWA, Issler H, Massam M, Reynolds EOR (1984) Treatment of neonatal pulmonary interstitial emphysema by lung puncture. Lancet I:1010–1011
Ng KPK, Easa D (1979) Management of interstitial emphysema by high frequency low positive pressure hand ventilation in the neonate. J Pediatr 95:117–118
Plenat F, Vert P, Didier F, André M (1978) Pulmonary interstitial emphysema. Clin Perinatol 5:351–375
Wissel TE, Clarck RH, Null DM, Kuehl TJ, de Lemos RA, Coalson JJ (1988) Tracheal and bronchial injury in high frequency compared with conventional ventilation. J Pediatr 112:249–256
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Morisot, C., Kacet, N., Bouchez, M.C. et al. Risk factors for fatal pulmonary interstitial emphysema in neonates. Eur J Pediatr 149, 493–495 (1990). https://doi.org/10.1007/BF01959402
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01959402