Ectopic
air leaks can occur in newborn infants.
There are several types:
Pulmonary interstitial emphysema (PIE) - air in the interstitial
lung spaces.
Pneumothorax - air in the pleural space.
Pneumomediastinum - air in the anterior mediastinum.
Pneumopericardium - air in the pericardial space.
Pneumoperitoneum - air in the peritoneal cavity.
Pneumoscrotum - air in the scrotum.
Air embolus - air descending into pulmonary veins and disseminating
throughout the blood stream.
Surgical emphysema - air in the subcutaneous tissue.
Clinical Presentation
The clinical presentation
of the various types of air leak syndromes are similar. In the mildest
forms, pneumothorax, pneumomediastinum and pneumopericardium may be
asymptomatic. However there is usually a deterioration in the baby’s
condition - usually sudden.
General signs include:
increasing oxygen
and/or ventilation needs
agitation
unstable vital signs
(e.g. HR ↓ SpO2 ↓)
As a tension pneumothorax develops and enlarges:
cyanosis develops
↑ work of
breathing
a mediastinal shift may
be noted
diminished air entry on
the affected side
In an advanced state of
tension pneumothorax:
apnoea
bradycardia
abrupt drop in blood
pressure and pulse pressure
unequal chest movement
poor peripheral
perfusion
Cyanosis of the head with
pallor of the trunk may occur in tension pneumothorax or pneumopericardium.
Peripheral
pulses are weak.
During pneumopericardium
tamponade of the heart occurs:
cardiac output decreases
heart rate increases
perfusion becomes poor
blood pressure and pulse pressure drop
heart sounds become muffled
In air embolism:
air popping in the heart can be heard
with a stethoscope
