Pulmonary Air Leaks of the Neonate

Abstract

Pulmonary air leaks of the newborn can be lifethreatening 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.