Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants

Abstract

Objective: We studied the ante-and postnatal risk factors and clinical outcomes associated with pulmonary interstitial emphysema (PIE) in extremely low birth weight infants (ELBW, <1000 g at birth) in the present era of tocolytics, antenatal steroid and postnatal surfactant administration. Study design:This was a retrospective case-controlled study of all ELBW admitted consecutively during a designated study-period in a level III nursery. Data were analyzed by performing univariate and multivariate analysis as applicable.Results: Infants with PIE had lower 1 and 5 min Apgar scores (P ¼ 0.04 and 0.003 respectively), increased surfactant utilization (P ¼ 0.004), higher maximum inspired oxygen concentration (P ¼ 0.04) and mean airway pressure administration (P ¼ 0.02) during the first week of life, and increased neonatal mortality (P ¼ 0.01). They received higher antenatal doses of magnesium sulfate (MgSO 4 ) (P ¼ 0.02). 56% of infants with PIE were exposed to more than 10 g of MgSO 4 (Mg10), compared to 15% in non-PIE group (P ¼ 0.01). The multivariate logistic regression analysis including significant co-variates revealed an independent association between Mg10 and PIE (P ¼ 0.01, Odds ratio 19.8, 95% CI 1.5-263).Conclusion: Pulmonary interstitial emphysema is associated with increased mortality in ELBW infants. Mg10 is an independent risk factor for PIE in this population.

Impact of Birth Weight and Smoking on Lung Function in Patients with Asthma, COPD, and Healthy Volunteers

“…Inter alia, Hyde et al [8] showed that in a group of preterm born children who had a LBW and BD, a higher prevalence of COPD was observed. Other studies displayed the frequent coexistence of emphysema with LBW [9,10]. Independent of smoking influence on asthma, the FVC% levels observed in this study was also confirmed in previous studies [11,12].…”

Pneumothorax in Neonate

“…and though incidence is less term neonate, may occur in spontaneously or with meconium aspiration syndrome .12 Air leaks are associated with an increased risk of intra-ventricular hemorrhage. 13 There was a 13 fold increase in the composite outcome of death or broncho-pulmonary dysplasia if a pneumothorax occurs in first 24 hours of life of preterm baby.…”

High-Frequency Oscillatory Ventilation with Low Oscillatory Frequency in Pulmonary Interstitial Emphysema

“…Pulmonary interstitial emphysema (PIE) is a vexing respiratory disease affecting preterm infants and is associated with a high risk of chronic respiratory morbidity and occasional mortality [1,2,3,4]. PIE is directly attributable to the unique vulnerability of the preterm lung to positive pressure ventilation, in particular the propensity for dilatation and rupture of the terminal bronchioles in the face of downstream atelectasis.…”