Causes and management of pulmonary air leaks

Pulmonary air leaks occur more frequently in the newborn period, particularly in ventilated, low birth weight infants, than at any other age. Pneumothorax and pulmonary interstitial emphysema are the most common forms of pulmonary air leak in the newborn period; other presentations include pneumomediastinum, pneumopericardium, pneumoperitoneum and subcutaneous emphysema. Pulmonary air leaks occur when there is uneven alveolar ventilation, air trapping and high transpulmonary pressure swings and hence are commoner in infants with underlying lung disease who require ventilatory support. Symptomatic infants will usually require drainage of a pneumothorax, strategies for the management of other air leaks include high frequency ventilation. The incidence of pulmonary air leaks has decreased with the use of exogenous surfactant therapy and high frequency positive pressure ventilation and volume targeted ventilation, but still result in mortality and morbidity.