Section of Neonatology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Pediatr Pulmonol. 2021 Jan;56(1):83-87. doi: 10.1002/ppul.25112. Epub 2020 Oct 20.
Pulmonary interstitial emphysema (PIE) is a pathological state when air escapes from ruptured alveoli and is trapped along the sheaths surrounding the bronchovascular bundle. PIE is not uncommon in infants who require mechanical ventilation and even less common in infants on noninvasive ventilatory support; however, it is extremely unusual in infants in room air.
A 2-week-old male infant developed worsening tachypnea in the special-care nursery. The patient was born at 33 weeks' gestation by induced vaginal delivery due to pre-eclampsia. He required positive pressure ventilation at birth and was admitted to the neonatal intensive care unit on nasal continuous positive airway pressure. On the second day of life, exogenous surfactant was administered via endotracheal tube due to increased oxygen requirement, and, soon after, he was weaned off all respiratory support. After 10 days of stability, he developed tachypnea with diminished air entry on the left side of the chest. Chest radiograph and chest computerized tomography confirmed left-sided unilateral PIE. The patient was treated conservatively with positional therapy alone. Significant clinical and radiographic improvement was noticed within 4 days; almost complete resolution by 10 days and the infant was discharged 23 days later. At follow-up at 7 months, the infant was found to be symptom-free with a normal chest radiograph.
Traditional management of unilateral PIE generally involves a combination of invasive ventilatory support and positional therapy to break the vicious cycle pathophysiology of PIE. This report focuses on the insidious progression of PIE in nonventilated neonates and describes a nontraditional conservative management strategy for the management of unilateral PIE.
肺间质气肿（PIE）是一种肺泡破裂导致空气逸出并沿支气管血管束鞘被捕获的病理状态。PIE 在需要机械通气的婴儿中并不少见，在接受无创通气支持的婴儿中甚至更少见；然而，在处于室内空气环境的婴儿中，这种情况极其罕见。
一名 2 周大的男性婴儿在特别护理病房出现呼吸急促加重的情况。该患者因子痫前期，经诱导性阴道分娩，孕 33 周时出生。出生时他需要正压通气，并因需要增加氧气供应，通过气管内管给予外源性表面活性剂，随后他被转至新生儿重症监护病房接受经鼻持续气道正压通气治疗。在出生后的第二天，由于氧需求增加，他接受了经气管内管给予外源性表面活性剂的治疗，此后他很快就停止了所有呼吸支持。在稳定 10 天后，他出现了呼吸急促，左侧胸部呼吸音减弱。胸部 X 线和胸部计算机断层扫描（CT）证实了左侧单侧 PIE。该患者仅接受体位治疗进行保守治疗。4 天内观察到明显的临床和影像学改善；10 天后几乎完全缓解，23 天后婴儿出院。在 7 个月的随访时，发现婴儿无症状，胸部 X 线正常。
单侧 PIE 的传统治疗方法通常包括侵入性通气支持和体位治疗相结合，以打破 PIE 的恶性循环病理生理学。本报告重点介绍了非通气新生儿中 PIE 的隐匿性进展，并描述了单侧 PIE 非传统保守管理策略。
