Donnelly Peter, McVea Steven, Flannigan Christopher, Bali Sanjeev
Department of Paediatric Intensive Care Unit, The Royal Belfast Hospital for Sick Children, Belfast, UK.
Royal Belfast Hospital for Sick Children, Belfast, UK.
BMJ Case Rep. 2016 Jun 29;2016:bcr2016215419. doi: 10.1136/bcr-2016-215419.
A 6-day-old term neonate who was intubated on day 1 of life for apnoeic episodes, was transferred to the regional paediatric intensive care unit (PICU) for specialist opinion following 3 failed extubations in the neonatal unit. Escherichia coli congenital pneumonia was diagnosed and the child discharged to the local hospital. Chest radiographs and inflammatory markers were in keeping with infection. However, ongoing difficulties with secretions necessitated readmission to the PICU, following a significant cyanotic episode associated with coughing. On arrival at the PICU, a large leak around the endotracheal tube (ETT) was noted. On direct laryngoscopy, the ETT was found correctly positioned, through the cords, but air was noted to be coming back from the oesophagus. Advancing the ETT towards the carina terminated the leak and raised the suspicion of a tracheo-oesophageal fistula. An H-type tracheo-oesophageal fistula was confirmed on bronchoscopy. An uneventful fistula repair was performed and the baby discharged from the PICU on day 23 of life.
一名足月儿，出生第1天因呼吸暂停发作而插管，在新生儿病房3次拔管失败后，被转至地区儿科重症监护病房（PICU）寻求专家意见。诊断为大肠杆菌先天性肺炎，患儿出院后转至当地医院。胸部X光片和炎症指标与感染相符。然而，由于分泌物持续存在问题，在一次与咳嗽相关的严重发绀发作后，患儿再次入住PICU。到达PICU时，发现气管内插管（ETT）周围有大量漏气。直接喉镜检查时，发现ETT位置正确，通过声带，但有空气从食管回流。将ETT向隆突推进后漏气停止，这增加了气管食管瘘的怀疑。支气管镜检查证实为H型气管食管瘘。瘘管修复手术顺利，患儿在出生第23天从PICU出院。
