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Madani Kia T, McKinney M, Dicken B, Thompson A, Sarlieve P, Law BHY. Clinical curiosity: How long should we wait? Management of ventilator associated pneumatocele in an extremely preterm infant. Pediatr Pulmonol 2024. [PMID: 38193785 DOI: 10.1002/ppul.26834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Tina Madani Kia
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Martha McKinney
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Bryan Dicken
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Adrienne Thompson
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Philippe Sarlieve
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
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Perdue S, Newberry D. Methicillin-Resistant Staphylococcus aureus Pneumatoceles in a Neonate With Sotos Syndrome : A Case Report. Adv Neonatal Care 2023; 23:409-417. [PMID: 37191941 DOI: 10.1097/anc.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus can lead to the formation of pneumatoceles in the lungs. Standard treatment guidelines are not available due to the rarity of pneumatoceles in neonates. CLINICAL FINDINGS Baby H. required prolonged respiratory support and supplemental oxygen to maintain appropriate oxygen saturation parameters for infants more than 34 weeks' gestation corrected. He was found to have multiple pneumatoceles in both lungs on different radiological modalities. PRIMARY DIAGNOSIS Baby H. was a former 32.2-week gestation male infant diagnosed with pneumonia caused by necrotizing methicillin-resistant Staphylococcus aureus leading to pneumatocele formation in both lungs. INTERVENTIONS Baby H. was managed with aggressive antibiotic therapy and then was conservatively managed until he received a tracheostomy tube on day of life (DOL) 75 to prepare for discharge home. OUTCOMES Baby H. was discharged from the neonatal intensive care unit (NICU) on DOL 113 with a tracheostomy tube for prolonged mechanical ventilatory support and a gastrostomy tube for nutrition. Numerous follow-up appointments with specialists have occurred since discharge. PRACTICE RECOMMENDATIONS While methicillin-resistant Staphylococcus aureus pneumatoceles are uncommon in the NICU setting, it is important for neonatal care providers to be aware of the causes and treatment choices currently available. Although conservative therapy is commonly utilized, it is important that nurses learn other available management strategies such as the ones highlighted in this article to best advocate for their patients.
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Tachikawa J, Aizawa Y, Shimotsuma T, Kaneko T, Saitoh A. Multiple pneumatoceles and lung abscesses caused by early-onset E. coli sepsis in a preterm neonate. J Infect Chemother 2023; 29:414-417. [PMID: 36584814 DOI: 10.1016/j.jiac.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
Early-onset sepsis (EOS) is a serious and fatal illness in neonates, Group B Streptococcus and Escherichia coli are major causative pathogens. We report a case of EOS and pneumonia caused by E. coli in a preterm neonate with multiple pneumatoceles and lung abscesses. A male neonate weighing 1670g was delivered at 33 6/7 weeks' gestation by a mother with clinical chorioamnionitis. He showed respiratory distress soon after birth and developed septic shock. He was intubated and mechanical ventilation was started. E.coli was detected in blood culture obtained from both the patient and his mother. He developed multiple pneumatoceles and lung abscesses. Surgical drainage was complicated, cefotaxime was thus continued until day 74. Pneumatoceles and lung abscesses are complications of neonatal pneumonia, rarely reported by E. coli. Multiple lung abscesses in our patient are distinct from single abscesses in previous case studies of neonatal lung abscesses. We speculate that bacteremia along with pneumatoceles led to multiple lung abscesses in our patient. These complications require long-term antibiotic therapy, to minimize morbidity and mortality, and should thus be considered when managing EOS caused by E. coli.
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Affiliation(s)
- Jun Tachikawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Taiki Shimotsuma
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takayuki Kaneko
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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Hameedi S, Hu H, Angueyra C, Kabagambe S, Duron V, Parravicini E. Management of pneumatocele in an extremely low birth weight neonate with percutaneous pigtail catheter by ultrasound guidance. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bao W, Tian X, Hao H, Jin Y, Xie X, Yin D, Zhang Y, Chen X, Xue Y, Han L, Yang F, Zhang M. Is small airway dysfunction an abnormal phenomenon for patients with normal forced expiratory volume in 1 second and the ratio of forced expiratory volume in 1 second to forced vital capacity? Ann Allergy Asthma Immunol 2021; 128:68-77.e1. [PMID: 34551345 DOI: 10.1016/j.anai.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/27/2021] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The clinical significance of small airway dysfunction (SAD) determined with spirometry in patients with normal forced expiratory volume in 1 second (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) is controversial. OBJECTIVE To determine whether SAD presents histologic abnormalities in the setting of normal computed tomography (CT) imaging and FEV1 and FEV1/FVC. METHODS A cross-sectional study was performed in 64 patients undergoing thoracotomy for pulmonary nodules. Thoracic high-resolution CT (HRCT), bronchodilation test, and fractional exhaled nitric oxide (FENO) and its alveolar component (nitric oxide alveolar concentration [CANO]) were obtained before surgery. Lung pathology and levels of cytokines in lung tissue were measured. The patients were divided into SAD and small airway normal function groups according to forced expiratory flow at 75% and 50% of the FVC (maximal expiratory flow [MEF] 25, MEF50) and maximum midexpiratory flow. RESULTS The MEF50, MEF25, and maximum midexpiratory flow were strongly negatively correlated with CANO (r, -0.42, -0.42, -0.40, respectively; P ≤ .001 for all). The MEFs were mildly negatively correlated with interleukin (IL)-6 and macrophages in lung tissue (r < -0.25, P < .001 for all). The CANO (P < .001), airspace size (mean linear intercept) (P = .02), macrophages (P = .003), IL-6 (P = .003), and IL-8 (P = .008) in lung tissue were higher in patients with SAD (n = 35) than those with small airway normal function (n = 29). A total of 8 patients (22.86%) with SAD and 2 (6.90%) without SAD had pneumatoceles (P = .10). CONCLUSION Patients with pulmonary nodules and SAD were more likely to have abnormal inflammation and emphysematous destruction than patients without SAD. Thus, SAD indicates histologic abnormalities in patients with normal CT imaging and FEV1 and FEV1/FVC.
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Affiliation(s)
- Wuping Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue Tian
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Hao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yubiao Jin
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueqian Xie
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongning Yin
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Chen
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fu Yang
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Muniraman H. Fetal lung fluid: Not the same as amniotic fluid. Pediatr Pulmonol 2021; 56:1270. [PMID: 33428825 DOI: 10.1002/ppul.25249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Hemananda Muniraman
- Neonatology Association Limited, Obstetrix Medical Group of Phoenix, Mednax, Division of Pediatrics, Creighton University School of Medicine, Phoenix Campus, Phoenix, Arizona, USA
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Muniraman H, Chintala S, Richardson R, Duarte A. Successful ultrasound guided percutaneous drainage of pneumatocele in an extremely preterm infant. Radiol Case Rep 2021; 16:607-611. [PMID: 33456637 PMCID: PMC7797481 DOI: 10.1016/j.radcr.2020.12.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 12/02/2022] Open
Abstract
Pneumatoceles are air filled, thin-walled cystic lesions with in the lung parenchyma that occur infrequently in neonates and infants, often as a complication of positive pressure ventilation, air leak syndrome or ventilator associated pneumonia. Whilst majority of pneumatoceles regress spontaneously over days to weeks, few large pneumatoceles may lead to acute cardiorespiratory insufficiency and may require drainage under computerized tomography or fluoroscopic guidance. We present a case report of an unstable extreme preterm infant with a large pneumatocele and respiratory failure, that was treated successfully by drainage under bedside ultrasound guidance.
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Affiliation(s)
- Hemananda Muniraman
- Neonatal Associates Limited, Mednax, USA.,St Joseph's Hospital and Medical Center, Arizona, USA.,Creighton University School of Medicine, Nebraska, USA
| | - Soumini Chintala
- Neonatal Associates Limited, Mednax, USA.,St Joseph's Hospital and Medical Center, Arizona, USA.,Creighton University School of Medicine, Nebraska, USA
| | - Randy Richardson
- St Joseph's Hospital and Medical Center, Arizona, USA.,Creighton University School of Medicine, Nebraska, USA
| | - Andrew Duarte
- St Joseph's Hospital and Medical Center, Arizona, USA
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