INTERSTITIAL EMPHYSEMA OCCURRING IN PERINATAL PERIOD (P25.0)

Abstract

A clinical case of interstitial emphysema of the lungs (IEL) in a preterm infant is discussed in the article, and the findings concerning epidemiology, etiopathogenesis, clinical manifestation, diagnostics, treatment and prevention of IEL in newborns are presented. IEL, air accumulation in the interstitial space of the lungs, is a wide-spread disease of the respiratory system in preterm infants characterized by a high risk of chronic af fliction of the lungs or death.As a result of alveolar and terminal bronchioles rupture against the ground of artificial lung ventilation (ALV) the air which have penetrated into the interstitial space puts pressure on the lung tissue and vessels, disturbs lung ventilation and blood circulation, reduces gas exchange resulting in pulmonary hypertension and blood shunting from the right to the left. The risk factors of IEL are: respiratory distress syndrome (RDS), deep morphofunctional immaturity, lung ventilation with a high positive pressure, meconium aspiration syndrome, infections, asphyxia, introducing high doses of magnesium sulfate.Clinical manifestation of IEL is characterized by the increase of respiratory failure against ALV, development of systemic hypotension and severe hypoxemia. X-ray of the lungs detects circular and longitudinal areas of intensified transparence forming a rough reticular picture. In 75% of infants the development of IEL is complicated by pneumothorax development, practically in half of them intraventricular bleeding occurs, air embolism may occur. In future the infants with IEL have a higher risk of the development of bronchopulmonary dysplasia (32%) and chronic lobular emphysema (19%).The treatment of IEL is conducted in intensive care units. Respiratory therapy is directed to preventand reduce barotrauma; expiratory pressure and an average pressure in the respiratory tract should be reduced to minimum enabling to maintain adequate parameters of acid-base balance and gases in the blood. High frequency (oscillatory) ALV is proved to be more ef fective than traditional ALV.Prevention of RDS in severely preterm infants by means of introducing glucocorticoids to mother and early administration of surfactant to her baby reduces the risk of IEL development.