Vascular air embolism in neonates: a literature review.

Background Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date, and provide up-to-date information about patient characteristics, clinical presentations, outcomes, pathogenesis, diagnosis, prevention, treatment and prognosis. Methods We searched the literature for case reports of neonatal vascular air embolism, using MEDLINE, CINAHL and EMBASE, and key words "neonatal" and "vascular air embolism". Results were summarized. Results There were 117 cases of neonatal vascular air embolism, with mean gestational age 30.4 weeks (range 23-40), mean birth weight 1422 grams (range 830-3844), and median age of occurrence 2 days (range 1-540) after birth. The majority were preterm (75.2%), male (62.7%), on assisted respiratory support (90.5%), and had air leak syndrome (52.9%). The most common clinical presentation was sudden acute clinical deterioration, sometimes accompanied by crying, cardiac rhythm abnormalities, skin discoloration, and decrease in end tidal carbon dioxide concentration. Incidence of mortality and adverse neurological sequelae among survivors were 73.9% and 16.6% respectively overall, but significantly (p<0.05) higher among preterm infants (81.8% and 31.2% respectively) and lower among surgical infants (23.8% and 0% respectively). Diagnosis included visualizing air in infusion lines or retinal vessels, decrease in the end-tidal carbon dioxide levels, and radiographic, doppler ultrasound, transesophageal echocardiography or computed tomography (CT) imaging. Conclusions Prognosis for neonatal air embolism is poor, especially for preterm infants requiring mechanical ventilation. Prevention is key and treatment is supportive.