Images in Clinical Medicine
Neonatal Pneumomediastinum
N Engl J Med 2001; 344:1839June 14, 2001
- Article
Figure 1 A male infant who had been delivered by elective cesarean section to a healthy 41-year-old woman at 38 weeks' gestation presented at 23 hours of age with increasing respiratory distress. Although well at birth, he began to have respiratory distress shortly afterward and required increasing concentrations of oxygen (maximal fractional concentration of oxygen in inspired gas, 70 percent) before being transferred to our facility. Blood cultures taken at the referring hospital were sterile after 48 hours of incubation. Chest x-ray films obtained on admission to our facility showed a large quantity of air in the mediastinum (Panels A and B), causing elevation of the thymus and partial collapse of the lungs on both sides. There was no evidence of cardiovascular compromise. Arterial blood gas measurements showed an acceptable level of gas exchange. The ambient oxygen concentration was increased to yield a fractional concentration of oxygen in inspired gas of 80 percent. The patient was monitored closely over the next 12 hours. By 48 hours of age his respiratory distress began to resolve. Chest x-ray films obtained at 60 hours of age showed complete resorption of the pneumomediastinum. Neither mechanical ventilation nor insertion of mediastinal drains proved necessary.
Neonatal pneumomediastinum occurs in approximately 2.5 per 1000 live births. The infant is often asymptomatic. This condition may follow gas trapping associated with the neonatal respiratory distress syndrome, pneumonia, or the use of mechanical ventilation. Neonatal pneumomediastinum is also associated with the aspiration of meconium or blood and birth-related trauma.
Doug Hacking, M.D.
Michael Stewart, M.D.
Royal Children's Hospital, Melbourne, Victoria, Australia- Citing Articles (2)
Citing Articles
1
Young June Choe, Eun Sun Kim, Ee-Kyung Kim, Han-Suk Kim, Jung-Eun Chun, Woo Sun Kim, In-One Kim, Jung-Hwan Choi. (2010) Decreased heart sound in a healthy newborn: Spontaneous multiseptated cystic pneumomediastinum with delayed respiratory distress. Korean Journal of Pediatrics 53:2, 244
CrossRef2
YEN-CHIEH WANG, JINN-MING WANG, YUNG-CHIONG CHOW, ALLEN W CHIU, STONE YANG. (2004) Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis. International Journal of Urology 11:10, 909-911
CrossRef
