Overview
Neonatal pulmonary air leak encompasses conditions where air escapes into the pleural space, mediastinum, or systemic circulation, often associated with assisted respiratory support and frequently seen in preterm infants 1.Diagnosis
Sudden acute clinical deterioration, including crying, cardiac rhythm abnormalities, and decreased end-tidal CO2 1.
Radiographic findings: pneumothorax, pneumomediastinum, pulmonary interstitial emphysema (PIE), and pneumopericardium 2.
Presence of isolated systemic venous air more frequently than arterial air, with right-sided cardiac air more common than left 2.Management
Immediate cessation of mechanical ventilation and careful suctioning to prevent further air entry 1.
Supportive care including hemodynamic monitoring and management of cardiovascular instability 1.
Surgical intervention may be required for persistent air leaks or complications like pneumothorax 1.Special Populations
Preterm infants are predominantly affected, with 75.2% of cases being preterm 1.
Infants on assisted respiratory support are at higher risk (90.5%) 1.Key Recommendations
Closely monitor infants on assisted respiratory support for signs of air leak syndrome, including sudden deterioration and radiographic changes (Evidence: Moderate 12).
Promptly address and manage air leaks to prevent systemic embolization, focusing on ventilatory adjustments and surgical consultation if necessary (Evidence: Weak 1).
Evaluate radiographic patterns for predominance of venous air involvement, particularly right-sided cardiac air, to guide understanding of pathogenesis (Evidence: Moderate 2).References
1 Zhou Q, Lee SK. Vascular Air Embolism in Neonates: A Literature Review. American journal of perinatology 2025. link
2 Booth TN, Allen BA, Royal SA. Lymphatic air embolism: a new hypothesis regarding the pathogenesis of neonatal systemic air embolism. Pediatric radiology 1995. link