Acute respiratory failure associated with intrathoracic masses in neonates.
BACKGROUND
Intrathoracic masses are uncommon in children. Occasionally, they present with acute respiratory failure in the neonatal period. Although emergency resection usually is the treatment of choice, other modalities are sometimes necessary to stabilize the patient.


METHODS
Seven neonates with intrathoracic masses were treated. Five had congenital cystic adenomatoid malformations (CCAM), 1 had a mediastinal teratoma, and 1 had a pneumatocele. These cases were reviewed retrospectively.


RESULTS
Four of the 7 infants had respiratory failure in the neonatal period. A patient with a large mediastinal teratoma and 1 with a CCAM that increased rapidly after presentation underwent emergency operation, relieving respiratory distress. The other 2 large CCAMs presented with severe respiratory distress immediately after birth because of pulmonary hypoplasia. One neonate with a Stocker-I CCAM died after emergency resection. One more recent patient with a Stocker-III CCAM survived after successful treatment with delayed resection, performed 3 days after birth. Nitric oxide (NO), and extracorporeal membrane oxygenation (ECMO) were instituted as supportive care because of profound persistent fetal circulation (PFC).


CONCLUSIONS
Acute respiratory failure associated with intrathoracic masses in neonates may be managed in 1 of 2 ways. A small mass that increases rapidly should be resected soon after presentation. In neonates with large masses with associated PFC, surgery can be delayed until the patient is stable. ECMO, NO, and high-frequency oscillation (HFO) can be used aggressively for stabilizing such neonates.
Seo
T
T
Department of Pediatric Surgery, Nagoya University Hospital, Japan.
Ando
H
H
Watanabe
Y
Y
Harada
T
T
Ito
F
F
Kaneko
K
K
Mimura
S
S
D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D009569:Nitric Oxide / Q000008:administration & dosage; D011247:Pregnancy; D011379:Prognosis; D011859:Radiography; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013896:Thoracic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D016216:Ultrasonography, Prenatal
D009569:Nitric Oxide