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  • Original Article
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Pneumatoceles in preterm infants—incidence and outcome in the post-surfactant era

Journal of Perinatology volume 30, pages 330–336 (2010)Cite this article

Abstract

Objective:

Pneumatoceles are gas-filled cysts within the lung parenchyma resulting mostly from ventilator-induced lung injury and air-leak in premature infants with respiratory distress syndrome. The use of surfactant in the treatment of respiratory distress syndrome has resulted in a decrease in the incidence of air-leak disease. Our aim was to study the incidence and clinical course of pneumatoceles in the surfactant era.

Study Design:

A retrospective study of infants born at ⩽30 weeks gestational age was admitted to the University of Connecticut Health Center NICU from 1998 to 2007. Pneumatoceles and other intrathoracic air-leaks were identified and comparisons were made with infants without these conditions.

Result:

Pneumatoceles were identified in 19 preterm infants, born at gestational age ⩽30 weeks, needing positive pressure ventilation for respiratory distress syndrome between the years 1998 to 2007. Pneumatoceles appeared early (median, 7th day of life; range, 1st to 28th day of life) and usually resolved with decrease in mean airway pressure (median, 4 days; range, 3 to 125 days). The majority of pneumatoceles were located in the right parahilar region (18/19). Associated intrathoracic air-leaks were pulmonary interstitial emphysema (5/19), pneumothorax (10/19), and pneumomediastinum (1/19). None of the infants required any invasive procedures to alleviate the pneumatoceles. In infants who survived, most pneumatoceles resolved with a decrease in mean airway pressure or extubation (14/15). One infant had a persistent pneumatocele for 125 days without any cardiopulmonary compromise and five infants died as a result air-leaks along with other complications of prematurity.

Conclusion:

Pneumatoceles are a manifestation of intrathoracic air-leaks of prematurity. They are markers for ventilator-induced lung injury and are associated with significant mortality similar to other intrathoracic air-leaks. However, conservative management with reduction in mean airway pressure is effective in the resolution of this condition and interventional decompression of the pneumatocele is generally not necessary.

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Acknowledgements

We thank Marta Barker and Ann Fracasso, from the neonatal database management team for their assistance with data search and retrieval.

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Author notes

  1. P Sharma: Deceased.

Authors and Affiliations

  1. Department of Pediatrics, University of Connecticut Health Center, Farmington, CT, USA

    N Hussain, P Sharma, M Pappagallo & A Bhandari

  2. Department of Radiology, University of Connecticut Health Center, Farmington, CT, USA

    T Noce

  3. Department of Radiology, St Mary's Hospital, Waterbury, CT, USA

    B Jagjivan

  4. Department of Pathology, University of Connecticut Health Center, Farmington, CT, USA

    P Hegde

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  1. N Hussain
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Correspondence to N Hussain.

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Hussain, N., Noce, T., Sharma, P. et al. Pneumatoceles in preterm infants—incidence and outcome in the post-surfactant era. J Perinatol 30, 330–336 (2010). https://doi.org/10.1038/jp.2009.162

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