Neonatal tension pulmonary interstitial emphysema in bronchopulmonary dysplasia: treatment with lateral decubitus positioning.

Persistent foci of tension pulmonary interstitial emphysema (TPIE) may represent a clinically significant threat to the neonate with bronchopulmonary dysplasia. A 5-year experience with 21 cases of TPIE is reported. These patients were treated with lateral decubitus positioning (LDP). The emphysematous side was placed down approximately 70% of the time for an average of slightly over 3 days. Progress was followed by serial chest radiographs. The overall success rate of LDP was 90%. Respiratory status either improved or remained stable in all responding neonates, and no proved complications were observed. The authors recommend lateral decubitus positioning as the initial treatment of choice in managing neonatal tension pulmonary emphysema.