Management of Air Leaks in the Newborn

BACKGROUND: Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing incidence, it continues to have a high morbidity and mortality rate. This makes PIE one of the most severe respiratory complications to affect a newborn. Air leaks occur when there is overdistension of the terminal airways or alveoli, which results in air dissecting into extra-alveolar spaces. Recognizing the signs of air leaks is paramount to allow for appropriate diagnosis and treatment of the newborn to improve morbidity and mortality. Treatment modalities range from positioning the newborn in the decubitus position to surgical intervention. PURPOSE: To summarize current evidence on the pathophysiology, risk factors, diagnosis, treatment, and management of PIE and pneumothorax. DATA SOURCES: Two databases were systematically reviewed with key words later. Articles in English with date restrictions from 2016 to current were included. STUDY SELECTION: Inclusion criteria of randomized controlled trials, case studies/reports, and review articles were utilized. Twenty articles, primarily case reports and studies, were reviewed. DATA EXTRACTION: Guidelines for data abstraction were followed via independent extraction by a single observer. RESULTS: Qualitative results were utilized to formulate current treatment of air leaks. IMPLICATIONS FOR PRACTICE: This article provides guidance for frontline neonatal providers on current treatment and management of air leaks in the newborn population.