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Stepwise multidisciplinary approach in very low birthweight infant with bronchopleural fistula
  1. Anna Milan1,
  2. Iain Yardley2,3,
  3. Grenville Fox1 and
  4. Virginie Meau-Petit1
  1. 1Neonatology, Evelina London Children's Hospital, London, UK
  2. 2Paediatric Surgery, Evelina London Children's Hospital, London, UK
  3. 3King's College London, Faculty of Life Sciences and Medicine, London, UK
  1. Correspondence to Dr Anna Milan; anna.milan{at}gstt.nhs.uk

Abstract

A 25-week gestation infant experienced chest infection complicated by septic shock and tension pneumothorax. Despite multiple drains, it was impossible to reinflate the lung, thus suggesting a bronchopleural fistula. Multidisciplinary meetings were arranged, involving the parents, and a stepwise approach was agreed. Chest drain repositioning, single lung ventilation and pleurodesis proved unsuccessful. In a rare window of relative stability, open chest surgery was performed at the cot-side by the paediatric general and cardiothoracic surgical teams. A large tear was identified at the carina, extending along the left main bronchus. This was repaired, with immediate clinical improvement. He was extubated 7 days later and discharged home on day 94 (CGA 39+0). This case report describes a successful stepwise multidisciplinary approach to a bronchopleural fistula in a very low birthweight infant, highlighting the potential for surgical intervention at cot-side and the value of involving the surgical team early on.

  • air leaks
  • neonatal intensive care
  • pneumothorax
  • paediatric surgery

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Footnotes

  • Twitter @grenvillefox

  • Contributors AM and VM-P actively participated in the management of the patient and wrote the manuscript. IY performed the surgery, wrote the surgical report and critically reviewed the manuscript. GF participated in the care of the patient, provided substantial contribution to conception and design of the article and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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