Stepwise multidisciplinary approach in very low birthweight infant with bronchopleural fistula

• Published in: BMJ case reports Vol. 14; no. 7; p. e241721
• Main Authors: Milan, Anna, Yardley, Iain, Fox, Grenville, Meau-Petit, Virginie
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 12.07.2021; BMJ Publishing Group
• Subjects: Babies; Birth weight; Bronchial Fistula - complications; Bronchial Fistula - surgery; Case Report; Case reports; Catheters; Chest Tubes; Fistula; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Intubation; Male; Mortality; Newborn babies; Ostomy; Pediatrics; Pleural Diseases - complications; Pleural Diseases - surgery; Pneumothorax; Sepsis; Surgery; Ventilators; paediatric surgery; neonatal intensive care; air leaks; pneumothorax
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2021-241721

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.