Downloaded from http://fn.bmj.com/ on October 22, 2015 - Published by group.bmj.com
Original article
IMAGES IN NEONATAL MEDICINE
Hypo-pharyngeal distension in an extremely low birth weight preterm infant A preterm male infant was born at 25 weeks gestation weighing 780 g by emergency caesarean section to a multiparous woman presenting in active labour with breech presentation. The infant needed some initial resuscitation by bag and mask ventilation followed by commencement of nasal bubble continuous positive airway pressure (CPAP) in the delivery room. Orogastric tube was placed without difficulty soon after birth. Due to a progressive increase in oxygen requirement, he was intubated by 3 h of life and surfactant was administered. He was successfully extubated back to CPAP by 8 h of age. On the third day of life a chest X-ray (CXR) revealed evidence of residual respiratory distress syndrome (RDS) and also an incidental finding of dilated hypopharynx. On review of this infant’s prior CXRs, there was dilated hypo-pharynx only on CXRs performed while the baby was on CPAP but not while intubated, with marked dilatation on the fourth day of life (figure 1). To our knowledge, ours is the second neonatal unit to report the presence of dilated hypopharynx with early CPAP delivery in preterm extremely low birth weight (ELBW) infants. In a unit that used nasal CPAP as their initial treatment of RDS in ELBW infants, gaseous distention of the pharynx and oesophagus was a relatively common occurrence.1 In this era of increased usage of CPAP in ELBW infants to reduce ventilator-associated lung injury and chronic
lung disease,2 3 an awareness that CPAP-related hypo-pharyngeal distention is common may help avoid unnecessary invasive investigations to rule out rare causes like oesophageal obstruction or hypo-pharyngeal perforation. B Sinha, I Castro-Aragon, E M Wachman, A M Fujii, B M Levesque Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA Correspondence to Dr B Sinha, Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA; [email protected] Competing interests None declared. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Sinha B, Castro-Aragon I, Wachman EM, et al. Arch Dis Child Fetal Neonatal Ed 2015;100:F500. Received 16 January 2015 Revised 17 March 2015 Accepted 25 March 2015 Published Online First 23 April 2015 Arch Dis Child Fetal Neonatal Ed 2015;100:F500. doi:10.1136/archdischild-2015-308247
REFERENCES 1
2 3
Walor D, Berdon W, Anderson N, et al. Gaseous distention of the hypopharynx and cervical esophagus with nasal CPAP: a mimicker of pharyngeal perforation and esophageal atresia. Pediatr Radiol 2005;35:1196–8. Pfister RH, Soll RF. Initial respiratory support of preterm infants: the role of CPAP, the INSURE method, and noninvasive ventilation. Clin Perinatol 2012;39:459–81. Levesque BM, Kalish LA, LaPierre J, et al. Impact of implementing 5 potentially better respiratory practices on neonatal outcomes and costs. Pediatrics 2011;128: e218–26.
Figure 1 Hypo-pharyngeal distension with CPAP therapy. F500
Wellington A, Perlman JM. Arch Dis Child Fetal Neonatal Ed 2015;100:F495–F500. doi:10.1136/archdischild-2015-308296
Downloaded from http://fn.bmj.com/ on October 22, 2015 - Published by group.bmj.com
Hypo-pharyngeal distension in an extremely low birth weight preterm infant B Sinha, I Castro-Aragon, E M Wachman, A M Fujii and B M Levesque Arch Dis Child Fetal Neonatal Ed 2015 100: F500 originally published online April 23, 2015
doi: 10.1136/archdischild-2015-308247 Updated information and services can be found at: http://fn.bmj.com/content/100/6/F500
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Articles on similar topics can be found in the following collections Child health (1445) Resuscitation (130) Competing interests (ethics) (96) Clinical diagnostic tests (694) Infant health (808) Journalology (104) Neonatal health (874) Radiology (667) Radiology (diagnostics) (612)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Original article
IMAGES IN NEONATAL MEDICINE
Hypo-pharyngeal distension in an extremely low birth weight preterm infant A preterm male infant was born at 25 weeks gestation weighing 780 g by emergency caesarean section to a multiparous woman presenting in active labour with breech presentation. The infant needed some initial resuscitation by bag and mask ventilation followed by commencement of nasal bubble continuous positive airway pressure (CPAP) in the delivery room. Orogastric tube was placed without difficulty soon after birth. Due to a progressive increase in oxygen requirement, he was intubated by 3 h of life and surfactant was administered. He was successfully extubated back to CPAP by 8 h of age. On the third day of life a chest X-ray (CXR) revealed evidence of residual respiratory distress syndrome (RDS) and also an incidental finding of dilated hypopharynx. On review of this infant’s prior CXRs, there was dilated hypo-pharynx only on CXRs performed while the baby was on CPAP but not while intubated, with marked dilatation on the fourth day of life (figure 1). To our knowledge, ours is the second neonatal unit to report the presence of dilated hypopharynx with early CPAP delivery in preterm extremely low birth weight (ELBW) infants. In a unit that used nasal CPAP as their initial treatment of RDS in ELBW infants, gaseous distention of the pharynx and oesophagus was a relatively common occurrence.1 In this era of increased usage of CPAP in ELBW infants to reduce ventilator-associated lung injury and chronic
lung disease,2 3 an awareness that CPAP-related hypo-pharyngeal distention is common may help avoid unnecessary invasive investigations to rule out rare causes like oesophageal obstruction or hypo-pharyngeal perforation. B Sinha, I Castro-Aragon, E M Wachman, A M Fujii, B M Levesque Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA Correspondence to Dr B Sinha, Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA; [email protected] Competing interests None declared. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Sinha B, Castro-Aragon I, Wachman EM, et al. Arch Dis Child Fetal Neonatal Ed 2015;100:F500. Received 16 January 2015 Revised 17 March 2015 Accepted 25 March 2015 Published Online First 23 April 2015 Arch Dis Child Fetal Neonatal Ed 2015;100:F500. doi:10.1136/archdischild-2015-308247
REFERENCES 1
2 3
Walor D, Berdon W, Anderson N, et al. Gaseous distention of the hypopharynx and cervical esophagus with nasal CPAP: a mimicker of pharyngeal perforation and esophageal atresia. Pediatr Radiol 2005;35:1196–8. Pfister RH, Soll RF. Initial respiratory support of preterm infants: the role of CPAP, the INSURE method, and noninvasive ventilation. Clin Perinatol 2012;39:459–81. Levesque BM, Kalish LA, LaPierre J, et al. Impact of implementing 5 potentially better respiratory practices on neonatal outcomes and costs. Pediatrics 2011;128: e218–26.
Figure 1 Hypo-pharyngeal distension with CPAP therapy. F500
Wellington A, Perlman JM. Arch Dis Child Fetal Neonatal Ed 2015;100:F495–F500. doi:10.1136/archdischild-2015-308296
Downloaded from http://fn.bmj.com/ on October 22, 2015 - Published by group.bmj.com
Hypo-pharyngeal distension in an extremely low birth weight preterm infant B Sinha, I Castro-Aragon, E M Wachman, A M Fujii and B M Levesque Arch Dis Child Fetal Neonatal Ed 2015 100: F500 originally published online April 23, 2015
doi: 10.1136/archdischild-2015-308247 Updated information and services can be found at: http://fn.bmj.com/content/100/6/F500
These include:
References Email alerting service
Topic Collections
This article cites 3 articles, 1 of which you can access for free at: http://fn.bmj.com/content/100/6/F500#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Child health (1445) Resuscitation (130) Competing interests (ethics) (96) Clinical diagnostic tests (694) Infant health (808) Journalology (104) Neonatal health (874) Radiology (667) Radiology (diagnostics) (612)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
