新生児エアリーク症例の臨床的検討

Abstract

We retrospectively analyzed the characteristics of infants complicated with pulmonary air leaks admitted to the neonatal intensive care unit. Forty infants with pulmonary air leaks were admitted to our neonatal intensive care unit between 1995 and 2004. The mean gestational ages and birth weights were 36.7 ± 5.6 weeks and 2488 ± 942g, respectively. The number and subtypes of air leaks were as follows: pneumothorax 29 (64%), pneumothorax and pneumomediastinum 5 (11%), pneumomediastinum 4 (9%), pneumopericardium 1 (2.5%) and pulmonary interstitial emphysema 1 (2.5%). Thirty-six (90%) infants developed air leaks within 24 hours after birth. The underlying diseases causing air leaks were transient tachypnea of the newborn (26%), meconium aspiration syndrome (17%), respiratory distress syndrome (15%), and so on. Eight infants (17%) were diagnosed as having spontaneous pneumothorax. Nine cases (22.5%) were very low birth weight infants. Premature infants tend to develop air leaks with respiratory distress syndrome, and term infants tend to develop air leaks with meconium asipiration syndrome. Four infants (10%) developed air leaks while on mechanical ventilators. For treatment, all infants required oxygen administration, and 9 infants improved spontaneously. Pleuracentesis was conducted in 8 infants, and 6 infants required continuous air drainage after pleuracentesis. Mechanical ventilation including nasal CPAP was performed in 23 infants. Intraventricular hemorrhage, which is known as a major complication of pulmonary air leaks, occurred in 3 infants (7.5%). Four infants (10%) died of the underlying diseases, and 36 infants survived without complications. It is important to consider the presence of air leaks in patients with respiratory abnormalities, and emergent treatments are necessary to prevent complications including intraventricular hemorrhage.