Pulmonary air-leak syndromes

[Britney]

Pulmonary air-leak syndromes involve dissection of air out of the normal pulmonary airspaces.
(See also Overview of Perinatal Respiratory Disorders.)
Extensive physiologic changes accompany the birth process, sometimes unmasking conditions that posed no problem during intrauterine life. For that reason, a person with neonatal resuscitation skills must attend each birth. Gestational age and growth parameters help identify the risk of neonatal pathology.
Air-leak syndromes include

Pulmonary interstitial emphysema
Pneumomediastinum
Pneumothorax
Pneumopericardium
Pneumoperitoneum or subcutaneous emphysema (rare)

Pneumothorax and pneumomediastinum occur in 1 to 2% of normal neonates, probably because large negative intrathoracic forces created when the neonate starts breathing occasionally disrupt alveolar epithelium, which allows air to move from the alveoli into extra-alveolar soft tissues or spaces.
Air leak is more common and severe among neonates with lung disease, who are at risk because of poor lung compliance and the need for high airway pressures (eg, in respiratory distress) or because of air trapping (eg, meconium aspiration syndrome), which leads to alveolar overdistention.
Many affected neonates are asymptomatic; diagnosis of air-leak syndromes is suspected clinically or because of deterioration in oxygen status and is confirmed by x-ray.
Treatment of air-leak syndromes varies by type of air leak but in ventilated infants always involves lowering inspiratory pressures to lowest tolerated settings. High-frequency ventilators may be helpful but are of unproven benefit.