Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report
Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery. Case Presentation...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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EL-Med-Pub
2023-01-01
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| Series: | Journal of Neonatal Surgery |
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| Online Access: | https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1165 |
| _version_ | 1797956532917239808 |
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| author | Heerani Woodun Jeremy Thomas Dushyant Batra Nia Fraser |
| author_facet | Heerani Woodun Jeremy Thomas Dushyant Batra Nia Fraser |
| author_sort | Heerani Woodun |
| collection | DOAJ |
| description |
Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery.
Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66.
Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.
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| first_indexed | 2024-04-10T23:51:29Z |
| format | Article |
| id | doaj.art-8c289dc12521422db477b7a446a9d999 |
| institution | Directory Open Access Journal |
| issn | 2226-0439 |
| language | English |
| last_indexed | 2024-04-10T23:51:29Z |
| publishDate | 2023-01-01 |
| publisher | EL-Med-Pub |
| record_format | Article |
| series | Journal of Neonatal Surgery |
| spelling | doaj.art-8c289dc12521422db477b7a446a9d9992023-01-10T18:40:15ZengEL-Med-PubJournal of Neonatal Surgery2226-04392023-01-011210.47338/jns.v12.1165Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case reportHeerani Woodun0Jeremy Thomas1Dushyant Batra2Nia Fraser3Department of Pediatric Surgery, Nottingham University Hospitals NHS Trust Department of Pediatric Surgery, Nottingham University Hospitals NHS Trust Department of Neonatology, Nottingham University Hospitals NHS TrustDepartment of Pediatric Surgery, Nottingham University Hospitals NHS Trust Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery. Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66. Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum. https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1165PneumothoraxTube thoracocentesisPrematureMassive air leakPneumoperitoneum |
| spellingShingle | Heerani Woodun Jeremy Thomas Dushyant Batra Nia Fraser Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report Journal of Neonatal Surgery Pneumothorax Tube thoracocentesis Premature Massive air leak Pneumoperitoneum |
| title | Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report |
| title_full | Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report |
| title_fullStr | Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report |
| title_full_unstemmed | Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report |
| title_short | Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report |
| title_sort | management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1 2kg preterm neonate a case report |
| topic | Pneumothorax Tube thoracocentesis Premature Massive air leak Pneumoperitoneum |
| url | https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/1165 |
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