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Early Pulmonary Interstitial Emphysema in the Newborn: A Grave Prognostic Sign

Department of Radiology, SUNY at Stony Brook, School of Medicine, Stony Brook, New York

Richard Sosulski

Department of Pediatrics, SUNY at Stony Brook, School of Medicine, Stony Brook, New York

Margarita B. Alarcon

Department of Radiology, SUNY at Stony Brook, School of Medicine, Stony Brook, New York

Chest radiographs and clinical records of 58 newborns with pulmonary interstitial emphysema (PIE) were reviewed to determine the diagnostic and prognostic significance of this finding in the first 24 hours of life. Thirty-nine infants developed PIE before 1 day of age (early PIE). In the absence of infection, early PIE was associated with younger gestational age, lower birth weight, lower 1 and 5 minute Apgar scores, and higher mortality, as compared with patients in whom air leak occurred later. Survival in infants with PIE seemed to be influenced mainly by coexisting risk factors such as extreme prematurity, birth asphyxia, and perinatal infection. Most cases of early PIE in newborns less than 30 weeks gestational age occurred at peak ventilation pressures < 25 cm H ₂O, and probably reflect increased sensitivity of the underdeveloped lung to barotrauma. In infants older than 30 weeks gestational age, early PIE was strongly associated with bacterial sepsis. These data indicate that the occurrence of PIE in the first 24 hours of life is a particularly ominous sign, and is frequently associated with clinical conditions which carry a poor prognosis.

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				M. D. Cabana, J. E. Benson, A. E. Smith, H. C. Baggett, and F. J. Northington Delayed Presentation of Pulmonary Interstitial Emphysema Clinical Pediatrics, May 1, 2000; 39(5): 299 - 302. [PDF]