Publications
Patching persistent pneumothorax in a neonate
Sumona Bose, Vishwas Rao, A. Nalina, Attibele Mahadevaiah Shubha AbstractIntroduction: Though autologous blood patch (ABP) pleurodesis is widely used in adults, its use in children is uncommon, with only one reported in a neonate thus far. Here, we report a late-preterm neonate with persistent air leak and concurrent Aspergillus infection, who was successfully treated with ABP, and we review the literature on pleurodesis.Case report: A late-preterm baby girl born at 35 weeks of gestation was referred with respiratory distress since birth. She required intubation and high-frequency oscillatory ventilation (HFOV) as she did not respond to conventional ventilation. On day 2 of life (D2), she developed left pneumothorax and, on D3, right pneumothorax, requiring intercostal chest tube drains (ICDs). The child was extubated on D14, and the right ICD was removed on D18. However, the left pneumothorax persisted. Computerized tomography revealed right-sided consolidation and pneumatoceles, and persistent left pneumothorax. ABP was done on D23 and D25, with resolution of pneumothorax and removal of ICD on D27. Concurrently, pleural fluid cultures done on D16, D23 and D25 grew Aspergillus terreus, which was treated with voriconazole. The child is well at 3 months follow-up.Conclusion: ABP for persistent pneumothorax is a safe, easy and inexpensive bedside procedure. Though its therapeutic role is well established in adults and older children, its use in neonates, especially in preemies, is less explored. The results are satisfactory, and it may be a feasible alternative to surgery when used in select neonates. IntroductionPleurodesis is an established treatment for “persistent pneumothorax” (persistent air leak [PAL] for more than 5 days) [1, 2]. Autologous blood patch (ABP) pleurodesis has been widely used in the adult population, with limited studies in children and only one in a neonate reported so far. Here, we report a late-preterm neonate having persistent pneumothorax and concurrent Aspergillus infection who was successfully treatedwith ABP pleurodesis.Case report A late-preterm baby girl born at 35 weeks of gestation by Caesarian section (indication: non-progression of labour) weighing 2.1 kg was referred to our Neonatal Intensive Care Unit for worsening respiratory distress on day 1 of life (D1). The baby had a respiratory distress syndrome (RDS) score of 7/10 at admission, required resuscitation, bag-mask ventilation, intubation and mechanical ventilation: initially synchronous intermittent mandatory ventilation (SIMV) and subsequently high-frequency oscillatory ventilation (HFOV). She received the appropriate dose of surfactant. On D2, she had an episode of desaturation with reduced air entry on the left side and a left pneumothorax, which improved with left intercostal chest drain (ICD) insertion. Right-sided pneumothorax was noted on D3, and a right ICD was placed (Fig. 1). The baby remained on HFOV till 7 days, following which she was gradually weaned to SIMV and extubated on D14. With improvement in ventilation, good lung expansion and nil ICD drainage, the right ICD was removed on D18. On the contrary, the left pneumothorax persisted in spite of treatment with antibiotics, ICD manipulation and reinsertion with ICD connected to an underwater seal. Following this, three-bottle continuous suction was tried for 2 days, but with no improvement. Chest X-ray (CXR) showed persistence and increase of left pneumothorax (Fig. 2), and contrast-enhanced computerized tomography (CECT) documented worsening of pneumothorax on the left side with right-sided consolidation and pneumatoceles. In view of the PAL, ABP pleurodesis was done. She received intravenous vancomycin and amikacin and the blood culture was sterile; however, serial pleural fluid cultures (done on D16, D23 and D25) revealed Aspergillus terreus, which was treated with voriconazole
