Premature babies who require artificial ventilation are at risk of interstitial pulmonary emphysema, where air leaks from the lungs into surrounding tissues. This condition is often associated with respiratory distress syndrome, which can make it more severe. Diagnosis is usually made through observations during ventilation and confirmed with a chest X-ray. Treatment includes positioning the baby to put pressure on the affected lung or using a special low-pressure rapid technique. Survivors may be more likely to suffer from lung disease in later life.
Interstitial pulmonary emphysema is a condition that can occur in babies who are born prematurely and need artificial ventilation because their lungs are not mature enough to function normally. The air passages in the lungs are divided into smaller and smaller branches, which end in small air sacs called alveoli, and in a premature baby, the pressure of the air pumped by a ventilator can cause the smaller tubes, which lead to the alveoli, tear away from their connecting branches. The air then escapes from the airways into the surrounding tissues.
Because interstitial pulmonary emphysema is most commonly associated with mechanical ventilation, children with lung disease and associated breathing difficulties are more at risk for the condition. Respiratory distress syndrome is one such lung disease, mostly seen in premature babies. It is caused by the premature baby having a lack of surfactant, the substance that normally coats the alveoli and prevents them from collapsing when the baby exhales. A surfactant substitute may be given, along with artificial ventilation, but infantile interstitial pulmonary emphysema may occur even at low pressures. This is because immature lungs may not stretch properly, causing the air tubes near the alveoli to rupture.
Respiratory distress syndrome can also cause fluid to build up in the tissues around the alveoli, and this can prevent air from escaping, making pulmonary interstitial emphysema more severe. The trapped air can constrict the lung, making breathing even more difficult and perhaps encouraging medical personnel to increase the ventilation pressure, if the condition has not been recognised. This can cause even more air to leak from the airways into the tissues, in a worsening cycle of events.
A diagnosis of this condition in infants, or newborns, usually arises as a result of observations made during ventilation. The condition is suspected if blood pressure and oxygen levels drop and ventilation becomes difficult, with the baby’s condition worsening. A chest X-ray may be used to confirm the diagnosis, and it may be seen that air has leaked in small areas in one lung, or it may spread diffusely in one lung or even through both lungs at the same time.
Where only one lung is affected by pulmonary interstitial emphysema, infants can be positioned to lie on their affected side, effectively putting pressure on the air leak and helping to stop its progression. This means that more air is available to keep the other unaffected lung inflated and breathing. Sometimes the healthy lung is gently ventilated. If both lungs are affected, ventilation can be done using a special low-pressure rapid technique. Although interstitial pulmonary emphysema can be fatal, recent treatment methods have improved the outlook, although survivors are more likely to suffer from lung disease in later life.
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