PULMONARY

INTERSTITIAL
EMPHYSEMA
What is pulmonary interstitial emphysema?

 Pulmonary interstitial emphysema (PIE) is when air gets trapped in the tissue outside of tiny air sacs
(alveoli) in the lungs. It affects newborn babies. PIE is fairly common in neonatal intensive care units
(NICUs).

 PIE usually affects low-weight infants who need a device (ventilator) that helps with breathing. These
infants often have a lung problem that is caused by preterm birth. PIE often affects infants in the first few
days of life. It may affect one or both lungs.

 PIE is classified by how long it lasts:

• ACUTE
• CHRONIC

 PIE may also be called diffuse or localized

 Pathophysiology

 PIE revealed alveolar hyperdistention, leading to tissue rupture. Some causes of air leaks and alveolar
rupture are insufflation (mechanical ventilation or positive pressure ventilation), since the lungs are
underdeveloped and sensitive to stretch.

 It is thought that overdistention of the lung leads to tearing of the septa with subsequent air passage into
the interstitial tissue. causing rupture into the pleural space

 The increased transpulmonary pressure, of the alveoli and airways, damages the respiratory epithelium.
GROSS
 MICROSCOPY

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What causes pulmonary interstitial
emphysema?

 PIE most often happens in preterm infants. It occurs when their lungs don't make
enough of a substance called surfactant. Surfactant allows alveoli to be more flexible
and less likely to break open.
Who is at risk for pulmonary interstitial
emphysema?
 Babies with a greater risk of PIE are those with the following conditions:

• Preterm birth, which often leads to respiratory disease

• The lungs don't develop correctly

• Breathing in the first intestinal discharge (meconium) at birth

• A lung infection

• Very fast breathing right after birth

What are the symptoms of pulmonary interstitial
emphysema?

 Signs of PIE often appear within 4 days of birth. Mild PIE may have no signs. More severe PIE may cause
signs of breathing trouble, such as:

• Grunting or other signs of trouble breathing

• Fast breathing

• Pale appearance

• Parts of the body tinted blue (cyanosis) due to low oxygen in the blood
How is pulmonary interstitial emphysema diagnosed?

 This may include information before, during, and after birth. Your child will have a
physical exam. His or her heart and lungs may be checked. Blood tests may be done to
look for signs of low levels of oxygen and high levels of carbon dioxide.

 Your child may likely have an imaging test, such as a chest X-ray or a chest CT scan.
Leaked air will often appear on both of these imaging tests.
How is pulmonary interstitial emphysema treated?

 Treatment is done to make sure your child gets enough oxygen. It also aims to prevent more air leaks.
Treatment may include:

• Lying your baby on the side with the air leak, which helps move more air into the lung that is working well

• Lowering ventilator pressure if possible, to help prevent more air leaks

• Using high-frequency oscillatory ventilation, which may lower pressure in the air sacs

• Giving extra oxygen

What are possible complications of PIE ?

• Pneumothorax

• Pneumomediastinum

• Pneumopericardium
How to prevent pulmonary interstitial emphysema?

 Preventing preterm birth may help prevent PIE. You can decrease the chance of preterm birth by:

• Not smoking during pregnancy

• Not using alcohol or drugs during pregnancy

• Getting early and regular prenatal care throughout your pregnancy

• Seeking medical attention at the first signs of preterm labor