ABSTRACT
Pulmonary air leaks include urgent life-threatening neonatal
emergencies like pulmonary interstitial emphysema, pneu-
momediastinum, pneumothorax, or pneumopericardium.14
The incidence of pulmonary air leaks in the neonates has
increased in recent years, possibly because an increasing
number of sick infants with respiratory distress on assisted
ventilation are now surviving to develop this complication.5
The sequence of events in the occurrence of pulmonary air
leaks is similar regardless of whether it is caused by uneven
alveolar ventilation, air trapping, and high transpulmonary
pressure swings. The rupture of terminal air sacs causes air to
escape into the pulmonary interstitium, resulting in pul-
monary interstitial emphysema. The air tracks along the
sheaths of pulmonary blood vessels to the lung hilum and air
may then rupture into mediastinum, pleura, or pericardium.6
It has also been suggested that air directly enters the pleural
cavity following a rupture of a subpleural bleb.7 Rarely,
systemic air embolism may be a terminal event of pulmonary
air leaks.8,9
