ACUTE LUNG INJURY IN
NEWBORNS -THE REPORT OF 3 CASES
Cai X-X, Han X-H, Xin
Y, Mao J, Bo T, Han Y-K
Department of
Pediatrics, The 2nd Clinical Hospital, China Medical University, Shenyang,
China
Objective: To discuss the diagnosis, clinical
features and treatment of acute lung injury in newborns.
Methods: Review of three cases of acute lung
injury in newborns with the clinical manifestations, blood gas,
radiological presentation and treatment.
Results: Three
full-term newborns, one male and two female infants, were deliveried by
cesarean section. Their average age was 3.5 hours in admission. There were
histories of fetal distress in two cases, severe perinatal asphyxia in two
cases and amniotic fluid or meconium aspiration in all three cases. Within a
few minutes after birth, dyspnea and respiratory failure were noted, but
hyaline membrane distress could be excluded. All infants had poor
oxygenation, PaO2/FiO2 ratio was 33mmHg, 70mmHg and 36mmHg respectively.
Radiography of the chest showed bilateral hazy and symmetric homogeneous
opacities with or without air bronchograms in two of three cases. In
another patient, dense bilateral consolidation of the lung that was similar
to "white-out" was seen. The cellular classification of tracheal
aspirates was done in two infants, then it was found that the ratio of
neutrophil to white blood cell was 0.74 and 0.72 respectively. No infant
had evidence of congestive heart failure. They required mechanical
ventilation, which last from 17 hours to 117 hours with FiO2≥ 0.5 for at least 13
hours. The highest peak inspiration pressure was 35cmH2O and the highest
positive end-expiration pressure was 6cmH2O. In one case, chest radiography
reveals pneumatocele at 21 hours of mechanical ventilation. Three infants
were cured.
Conclusion: Acute
lung injury in newborn has many features. If it is found and treated by
mechanical ventilation as early as properly, its outcome is good.