Skip to main content
SpringerLink
Log in

Pulmonary Air Leaks of the Neonate

  • Living reference work entry
  • First Online:
Pediatric Surgery

  • 230 Accesses

Abstract

Pulmonary air leaks of the newborn can be life-threatening emergencies and may lead to severe respiratory compromise. In order of descending incidence, pneumothorax, interstitial emphysema, pneumomediastinum, and pneumopericardium are the main presentations of neonatal pulmonary air leaks. Combinations of the different entities are frequently observed. Pathophysiologically, all of them are commonly caused by uneven ventilation, air trapping, and high transpulmonary pressure swings. The final common pathway of the four groups is alveolar overdistension and rupture of the alveolar sacs allowing the intrapulmonary air to evade into the different intrathoracic spaces.

The diagnostic gold standard is the chest x-ray. In asymptomatic children, pulmonary air leaks may be managed conservatively by reduction of ventilator pressures and increased inspired oxygen concentration favoring resorption of the extra-alveolar gas. However, careful observation of the neonate is recommended, and the threshold for drainage should be low, particularly in ventilated babies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Aranda JV, Stern L, Dunbar JS. Pneumothorax with pneumoperitoneum in a newborn infant. Am J Dis Child. 1972;123:163–6.

    CAS  PubMed  Google Scholar 

  • Cools F, Offringa M. Neuromuscular paralysis for newborn infants receiving mechanical ventilation. Cochrane Database Syst Rev. 2005;2:CD002773.

    Google Scholar 

  • Cools B, Plaskie K, Van de Vijver K, Suys B. Unsuccessful resuscitation of a preterm infant due to a pneumothorax and a masked tension pneumopericardium. Resuscitation. 2008;78(2):236–9.

    Article  PubMed  Google Scholar 

  • Dördelmann M, Schirg E, Poets CF, Ure B, Glüer S, Bohnhorst B. Therapeutic lung puncture for diffuse unilateral pulmonary interstitial emphysema in preterm infants. Eur J Pediatr Surg. 2008;18(4):233–6.

    Article  PubMed  Google Scholar 

  • Franco L, Vieira F, Marçal M, Tuna M. Neonatal spontaneous pneumomediastinum. Lung. 2014;192(5):819–20.

    Article  CAS  PubMed  Google Scholar 

  • Greenough A, Milner AD. Acute repiratory disease. In: Rennie JM, editor. Rennie and Robertson’s textbook of neonatology. 5th ed. London: Churchill Livingstone; 2012.

    Google Scholar 

  • Greenough A, Robertson NRC. Morbidity and survival in neonates ventilated for respiratory distress syndrome. Br Med J. 1985;290:597–600.

    Article  CAS  Google Scholar 

  • Greenough A, Dixon AK, Roberton NR. Pulmonary interstitial emphysema. Arch Dis Child. 1984;59(11):1046–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Greenough A, Dimitriou G, Prendergast M, Milner AD. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst Rev. 2008;1:CD000456.

    Google Scholar 

  • Greenough A, Murthy V, Milner AD, Rossor TE, Sundaresan A. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst Rev. 2016;8:CD000456.

    Google Scholar 

  • Hauri-Hohl A, Baenziger O, Frey B. Pneumomediastinum in the neonatal and paediatric intensive care unit. Eur J Pediatr. 2008;167(4):415–8.

    Google Scholar 

  • Henderson-Smart DJ, Cools F, Bhuta T, Offringa M. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. 2007;3:CD000104.

    Google Scholar 

  • Klinger G, Ish-Hurwitz S, Osovsky M, Sirota L, Linder N. Risk factors for pneumothorax in very low birth weight infants. Pediatr Crit Care Med. 2008;9(4):398–402.

    Article  PubMed  Google Scholar 

  • Lawal TA, Glüer S, Reismann M, Dördelmann M, Schirg E, Ure B. Spontaneous neonatal pneumomediastinum: the “spinnaker sail” sign. Eur J Pediatr Surg. 2009;19(1):50–2.

    Article  CAS  PubMed  Google Scholar 

  • Litmanovitz I, Carlo WA. Expectant management of pneumothorax in ventilated neonates. Pediatrics. 2008;122(5):e975–9.

    Article  PubMed  Google Scholar 

  • Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum, clinical applications. Arch Intern Med. 1939;64:913–26.

    Article  Google Scholar 

  • Madansky DL, Lawson EE, Chernick V, Taeusch Jr HW. Pneumothorax and other forms of pulmonary air leak in newborns. Am Rev Respir Dis. 1979;120(4):729–37.

    CAS  PubMed  Google Scholar 

  • Mandal AK, Yamini S, Bean X. Arterial blood gas and expiratory pressure monitoring in infants with pneumothorax: prognostic predictability. J Natl Med Assoc. 1990;82(1):33–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Matta R, Matta J, Hage P, Nassif Y, Mansour N, Diab N. Diffuse persistent interstitial pulmonary emphysema treated by lobectomy. Ann Thorac Surg. 2011;92(4):e73–5.

    Article  PubMed  Google Scholar 

  • Megremis S, Stefanaki S, Tsekoura T, Tsilimigaki A. Spontaneous pneumomediastinum in a child: sonographic detection in a case with minimal findings on chest radiography. J Ultrasound Med. 2008;27(2):303–6.

    Article  PubMed  Google Scholar 

  • Mehrabani D, Gowen CW Jr, Kopelman AE. Association of pneumothorax and hypotension with intraventricular haemorrhage. Arch Dis Child. 1991;66(1 Spec No):48–51.

    Google Scholar 

  • Messineo A, Fusaro F, Mognato G, Sabatti M, D’Amore ES, Guglielmi M. Lung volume reduction surgery in lieu of pneumonectomy in an infant with severe unilateral pulmonary interstitial emphysema. Pediatr Pulmonol. 2001;31(5):389–93.

    Article  CAS  PubMed  Google Scholar 

  • Monteiro R, Paulos L, Agro JD, Winckler L. Neonatal spontaneous pneumomediastinum and the Spinnaker-Sail sign. Einstein (Sao Paulo). 2015;13(4):642–3.

    Article  Google Scholar 

  • Morisot C, Kacet N, Bouchez MC, Rouland V, Dubos JP, Gremillet C, Lequien P. Risk factors for fatal pulmonary interstitial emphysema in neonates. Eur J Pediatr. 1990;149(7):493–5.

    Article  CAS  PubMed  Google Scholar 

  • Plenat F, Vert P, Didier F, Andre M. Pulmonary interstitial emphysema. Clin Perinatol. 1978;5:351–75.

    CAS  PubMed  Google Scholar 

  • Soll R, Ozek E. Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2010;1:CD001079.

    Google Scholar 

  • Trevisanuto D, Doglioni N, Ferrarese P, Vedovato S, Cosmi E, Zanardo V. Neonatal pneumothorax: comparison between neonatal transfers and inborn infants. J Perinat Med. 2005;33(5):449–54.

    Article  PubMed  Google Scholar 

  • Vanhaesebrouck P, Leroy JG, De Praeter C, Parijs M, Thiery M. Simple test to distinguish between surgical and non-surgical pneumoperitoneum in ventilated neonates. Arch Dis Child. 1989;64(1 Spec No):48–9.

    Google Scholar 

  • Yu VYK, Wong PY, Bajuk B, Symonowicz W. Pulmonary air leak in extremely low birth weight infants. Arch Dis Child. 1986;61:239–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UCD School of Medicine and Medical Science, National Children’s Research Centre, Our Lady’s Children’s Hospital, Dublin, Ireland

    Prem Puri

  2. Centre of Pediatric Surgery Hannover, Hannover Medical School and Bult Children’s Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Jens Dingemann

Authors
  1. Prem Puri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens Dingemann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prem Puri .

Editor information

Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag GmbH Germany

About this entry

Cite this entry

Puri, P., Dingemann, J. (2017). Pulmonary Air Leaks of the Neonate. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_54-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-38482-0_54-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-38482-0

  • Online ISBN: 978-3-642-38482-0

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation