Abstract
Background: Systemic air embolism is a rare but fatal complication in the course of neonatal intensive care patients. Risk factors are ventilatory support or central venous lines. We herein report two cases without a direct link to risk factors and with diverse outcome.
Case reports: The first patient was a male preterm triplet of 28 weeks gestational age, weighing 1180 g, treated with nasal CPAP and supplemental oxygen in the first hours of life. Parenteral fluid supply was administered by a peripheral intravenous catheter. At day 12 of life an aggravation of the patients general condition accompanied by livid discoloration of the upper leg and abdomen occurred. Ultrasonography demonstrated presence of intracerebral, intrarenal, intraintestinal and intracardiac air. 12 hours after the initial event the patient developed necrotizing enterocolitis, warranting abdominal surgery. The further clinical course was complicated by extensive periventricular leukomalacia with cerebral seizures. 9 weeks after the air embolism the patient died from decompensated congestive cardiomyopathy. Post-mortem examination revealed an infarction of the left ventricle. The other patient, a female preterm infant of 27 weeks gestational age with a birth weight of 735 g, was ventilated for 24 hours and then managed on CPAP at room air. On the third day of life a sudden deterioration with acute bradycardia required cardiopulmonary resuscitation which resulted in a small pneumothorax that resolved spontaneously. Air embolism was the suspected trigger of this episode. Ultrasound examination revealed air in heart, liver and brain. The patient was stabilized and showed no residual findings during the further clinical course.
Conclusion: In both cases a direct cause of the air embolism could not be revealed since common risk factors did not apply for both patients. Although the precise nature of this complication is not well understood the contrasting outcomes of the reported neonatal cases is striking.
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Weber, S., Hüseman, D., Bührer, C. et al. 410 Different Outcome After Air Embolism in Two Preterm Infants. Pediatr Res 58, 424 (2005). https://doi.org/10.1203/00006450-200508000-00439
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DOI: https://doi.org/10.1203/00006450-200508000-00439