Challenging acquired pulmonary interstitial emphysema in an extreme preterm infant: A case report and review of literature.

Background: Pulmonary interstitial emphysema (PIE) can occur in the immature lungs of preterm infants due to overdistension from mechanical ventilation.

Case Report: Preterm female infant (26 weeks of gestational age, 950 grams) born via urgent cesarean section, APGAR 1/3/6. Invasive mechanical ventilation during the first day of life transitioned to noninvasive positive pressure ventilation (NIPPV), afterward initially stable. Apnea and bradycardia noted at 20 days of life, requiring endotracheal intubation, with complementary studies showing right PIE. Progressive emphysema deterioration, air trapping, and left lung atelectasis, with hemodynamic repercussion despite positioning, high-frequency oscillatory ventilation, and hemodynamic support with dopamine and dobutamine. Selective left intubation attempted positioning the infant, unsuccessful. Due to failure of conventional therapies and impossibility to achieve selective intubation, pediatric surgery performed endobronchial balloon occlusion with angioplasty balloon inflated with contrast with fluoroscopy control. Progressive improvement, weaning ventilatory settings with acceptable oxygenation. Balloon was retired after 5 days. Mechanical ventilation was discontinued at 52 days of life. Infant was discharged without respiratory support nor oxygen at 100 days of life.

Conclusions: PIE treatment is based in conventional measures (respiratory support and positioning) but eventually might require alternative techniques when the first fail, with limited work in pediatric population and further technical limitations in the preterm infants.