Pneumatoceles in preterm infants-incidence and outcome in the post-surfactant era

J Perinatol. 2010 May;30(5):330-6. doi: 10.1038/jp.2009.162. Epub 2009 Oct 8.

Abstract

Objective: Pneumatoceles are gas-filled cysts within the lung parenchyma resulting mostly from ventilator-induced lung injury and air-leak in premature infants with respiratory distress syndrome. The use of surfactant in the treatment of respiratory distress syndrome has resulted in a decrease in the incidence of air-leak disease. Our aim was to study the incidence and clinical course of pneumatoceles in the surfactant era.

Study design: A retrospective study of infants born at < or =30 weeks gestational age was admitted to the University of Connecticut Health Center NICU from 1998 to 2007. Pneumatoceles and other intrathoracic air-leaks were identified and comparisons were made with infants without these conditions.

Result: Pneumatoceles were identified in 19 preterm infants, born at gestational age < or =30 weeks, needing positive pressure ventilation for respiratory distress syndrome between the years 1998 to 2007. Pneumatoceles appeared early (median, 7th day of life; range, 1st to 28th day of life) and usually resolved with decrease in mean airway pressure (median, 4 days; range, 3 to 125 days). The majority of pneumatoceles were located in the right parahilar region (18/19). Associated intrathoracic air-leaks were pulmonary interstitial emphysema (5/19), pneumothorax (10/19), and pneumomediastinum (1/19). None of the infants required any invasive procedures to alleviate the pneumatoceles. In infants who survived, most pneumatoceles resolved with a decrease in mean airway pressure or extubation (14/15). One infant had a persistent pneumatocele for 125 days without any cardiopulmonary compromise and five infants died as a result air-leaks along with other complications of prematurity.

Conclusion: Pneumatoceles are a manifestation of intrathoracic air-leaks of prematurity. They are markers for ventilator-induced lung injury and are associated with significant mortality similar to other intrathoracic air-leaks. However, conservative management with reduction in mean airway pressure is effective in the resolution of this condition and interventional decompression of the pneumatocele is generally not necessary.

MeSH terms

  • Cohort Studies
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Positive-Pressure Respiration / adverse effects*
  • Pulmonary Surfactants
  • Respiratory Distress Syndrome, Newborn / complications
  • Respiratory Distress Syndrome, Newborn / diagnosis
  • Respiratory Distress Syndrome, Newborn / therapy*
  • Retrospective Studies
  • Treatment Outcome
  • Ventilator-Induced Lung Injury / diagnosis
  • Ventilator-Induced Lung Injury / epidemiology*
  • Ventilator-Induced Lung Injury / therapy*

Substances

  • Pulmonary Surfactants