Neonatal air embolism

Abstract

Introduction: Air embolism is a complication that is rarely documented in Neonatal Intensive Care Units. It is secondary to alveolar rupture, placement of umbilical catheters, chest compressions, or medication administration. With the implementation of Point of Care Ultrasound (POCUS) programs, more cases have been identified. Clinical case: Preterm newborn of 30 weeks of gestation, with two ultrasound evaluations: the first at the time of admission because he presented hypotension, determining that he had transitional circulation with adequate biventricular function and low cardiac output. The second study was carried out because the newborn collapsed, after manipulation of umbilical catheters; observing a hyperechoic image with acoustic shadow “in a comet’s tail” in the right ventricular outflow tract, which generated obstruction. Tamponade, pneumothorax and pleural effusion were ruled out. Despite intensive management, the patient developed severe metabolic acidosis, hyperlactatemia and hypotension refractory, and subsequently died. Conclusion: Air embolism is a serious complication, which can go unnoticed and may be life threatening. Ultrasound seems to be a good tool for its detection, which should help to establish a timely management.