PT  - JOURNAL ARTICLE
AU  - Anna Milan
AU  - Iain Yardley
AU  - Grenville Fox
AU  - Virginie Meau-Petit
TI  - Stepwise multidisciplinary approach in very low birthweight infant with bronchopleural fistula
AID  - 10.1136/bcr-2021-241721
DP  - 2021 Jul 01
TA  - BMJ Case Reports
PG  - e241721
VI  - 14
IP  - 7
4099  - http://casereports.bmj.com/content/14/7/e241721.short
4100  - http://casereports.bmj.com/content/14/7/e241721.full
SO  - BMJ Case Reports2021 Jul 01; 14
AB  - 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.