Department of Neonatology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Department of Neonatology and Pediatric Intensive Care, Klinikum Aschaffenburg, Am Hasenkopf 1, Aschaffenburg, 63739, Aschaffenburg, Bavaria, Germany.
BMC Pediatr. 2019 Aug 1;19(1):267. doi: 10.1186/s12887-019-1640-2.
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.
We report the case of a 28gestational 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 pCO increased from 40 mmHg to 55 mmHg and FiO from 0.21 to 0.28 to achieve SpO 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.
For unilateral PIE in very preterm infants, positioning on the affected hemithorax without mechanical ventilation is a therapeutic option.
肺间质气肿（PIE）在极低出生体重儿中是一种罕见但严重的并发症。尽管大多数这些气漏发生在机械通气的婴儿中，但也有仅接受鼻持续气道正压通气（CPAP）的婴儿发生的报道。PIE 的最佳治疗方法仍在讨论中，包括不同的方法，如单侧插管、高频振荡通气甚至手术肺叶切除术。然而，迄今为止，尚无关于不使用机械通气通过体位治疗完全解决单侧 PIE 的报道。
我们报告了一例 28 孕周的双胞胎，出生体重 990 克，阿普加评分 9-10-10。在接受鼻 CPAP 稳定后，婴儿在生命后 35 分钟在产房接受了经鼻表面活性物质应用（LISA）技术的表面活性物质，然后继续接受鼻 CPAP 呼吸支持。第 5 天 X 线片显示单侧 PIE，同时 pCO 从 40mmHg 增加到 55mmHg，FiO 从 0.21 增加到 0.28，以达到 89-94%的目标 SpO。婴儿在高流量鼻插管（HFNC）下自主呼吸时，通过特殊夹板严格置于患侧胸部以治疗单侧 PIE。96 小时后，单侧 PIE 完全消退。未发生慢性肺病。
对于极早产儿单侧 PIE，不使用机械通气进行患侧体位治疗是一种治疗选择。
