Acute respiratory failure associated with intrathoracic masses in neonates

J Pediatr Surg. 1999 Nov;34(11):1633-7. doi: 10.1016/s0022-3468(99)90632-2.

Abstract

Background: Intrathoracic masses are uncommon in children. Occasionally, they present with acute respiratory failure in the neonatal period. Although emergency resection usually is the treatment of choice, other modalities are sometimes necessary to stabilize the patient.

Methods: Seven neonates with intrathoracic masses were treated. Five had congenital cystic adenomatoid malformations (CCAM), 1 had a mediastinal teratoma, and 1 had a pneumatocele. These cases were reviewed retrospectively.

Results: Four of the 7 infants had respiratory failure in the neonatal period. A patient with a large mediastinal teratoma and 1 with a CCAM that increased rapidly after presentation underwent emergency operation, relieving respiratory distress. The other 2 large CCAMs presented with severe respiratory distress immediately after birth because of pulmonary hypoplasia. One neonate with a Stocker-I CCAM died after emergency resection. One more recent patient with a Stocker-III CCAM survived after successful treatment with delayed resection, performed 3 days after birth. Nitric oxide (NO), and extracorporeal membrane oxygenation (ECMO) were instituted as supportive care because of profound persistent fetal circulation (PFC).

Conclusions: Acute respiratory failure associated with intrathoracic masses in neonates may be managed in 1 of 2 ways. A small mass that increases rapidly should be resected soon after presentation. In neonates with large masses with associated PFC, surgery can be delayed until the patient is stable. ECMO, NO, and high-frequency oscillation (HFO) can be used aggressively for stabilizing such neonates.

Publication types

  • Case Reports

MeSH terms

  • Extracorporeal Membrane Oxygenation
  • Female
  • Humans
  • Incidence
  • Infant, Newborn
  • Lung / abnormalities*
  • Lung / diagnostic imaging
  • Lung / surgery
  • Male
  • Mediastinal Neoplasms / complications
  • Mediastinal Neoplasms / diagnostic imaging
  • Mediastinal Neoplasms / surgery
  • Nitric Oxide / administration & dosage
  • Pregnancy
  • Prognosis
  • Radiography
  • Respiratory Distress Syndrome, Newborn / epidemiology
  • Respiratory Distress Syndrome, Newborn / etiology*
  • Respiratory Distress Syndrome, Newborn / therapy
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Thoracic Diseases / complications*
  • Thoracic Diseases / diagnostic imaging
  • Thoracic Diseases / surgery
  • Ultrasonography, Prenatal

Substances

  • Nitric Oxide