Surgical cause of respiratory distress in a newborn
Keywords:Respiratory distress, Hyperlucency, CLE
Common causes of respiratory distress in a term infant include transient tachypnoea of newborn, sepsis/congenital pneumonia and congenital heart diseases. Surgical causes of distress in a newborn are rare and should be considered when other causes have been ruled out. We report a case of an early term female neonate who developed respiratory distress immediately after birth which was gradually progressive and required respiratory support. On evaluation with chest radiography and CT, a diagnosis of congenital lobar emphysema (CLE) was made. Immediate surgical resection was planned and done on day 8 of life. Post operatively she had no respiratory distress and discharged within a week. Baby is now healthy with normal growth and development. Half of the cases of CLE are diagnosed within the first 6 months of life but very few cases present with respiratory distress since birth. Timely diagnosis and early surgical excision in neonates <2 months improve the outcome, as seen in our case.
Suryawanshi K, Nikumbh D, Singhavi S, Damle R, Dravid N. Congenital lobar emphysema with pulmonary extramedullary hematopoiesis. Turkish J Pathol. 2015;14:01291.
Correia-Pinto J, Gonzaga S, Huang Y, Rottier R. Congenital lung lesions-underlying molecular mechanisms. Seminars Pediatric Surg. 2010;19(3):171-9.
Stigers KB, Woodring JH, Kanga JF. The clinical and imaging spectrum of findings in patients with congenital lobar emphysema. Pediatr Pulmonol. 1992;14:160-70.
Thakral CL, Maji DC, Sajwani MJ. Congenital lobar emphysema: experience with 21 cases. Pediatr Surg Inter. 2001;17(2-3):88-91.
Fowler DJ, Gould SJ. The pathology of congenital lung lesions. Semin Pediatr Surg. 2015;24:176-82.
DeLuca FG, Wesselhoeft CW. Surgically treatable causes of neonatal respiratory distress. Clini Perinatol. 1978;5(2):377-94.
Bush A, Harcout J, Hewitt RJ, Nicholson AG. Congenital lung disease in: Wilmott RW, Deterding R, Li A editors Kendig’s Disorders of the Respiratory Tract in Children. 9th ed. Philadelphia (PA): Elsevier, Inc. 2019;321-2.
Kravitz RM. Congenital malformations of the lung. Pediatr Clin North Am. 1994;41(3):453-72.
Ankermann T, Oppermann HC, Engler S, Leuschner I, Von Kaisenberg CS. Congenital masses of the lung, cystic adenomatoid malformation versus congenital lobar emphysema: prenatal diagnosis and implications for postnatal treatment. J Ultrasound Med. 2004;23(10):1379-84.
Bappal B, Ghani SA, Chaudhary R, Sajvani MJ. Congenital lobar emphysema: A review of 10 cases. Indian J Pediatr. 1996;63:801-8.
Franken EA, Buehl I. Infantile lobar emphysema: report of two cases with unusual roentgenographic manifestations. Am J Roentgenol. 1966;98:354-7.
Fanaroff and Martin’s Neonatal-Perinatal Medicine E-Book: Elsevier. Diseases of the Fetus and Infant. 2019.
Olutoye OO, Coleman BG, Hubbard AM, Adzick NS. Prenatal diagnosis and management of congenital lobar emphysema. J Pediatr Surg. 2000;35(5):792-5.
Mani H, Suarez E, Stocker J. The morphologic spectrum of infantile lobar emphysema: A study of 33 cases. Paediatr Respiratory Reviews. 2004;5.
Taeusch HW, Ballard RA, Gleason CA. Averys diseases of the newborn. Estados Unidos: Elsevier. 2005.
McBride JT, Wohl ME, Strieder DJ. Lung growth and airway function after lobectomy in infancy for congenital lobar emphysema. J Clin Invest. 1980;66(5):962-70.