813 Management of Massive Air Leak with Persistent Pneumothorax and Pneumoperitoneum in a 1.2kg Preterm Neonate – a Case Report

Abstract Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum. Risk factors of spontaneous pneumothorax include prematurity, low birthweight, APGAR scores caesarean-section delivery. A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks gestation by emergency lower segment caesarean section. He showed signs respiratory distress after uncomplicated endotracheal tube insertion required due apnoeic episodes during continuous positive airway pressure ventilation. Recurring thoracocentesis high frequency oscillatory ventilation (HFOV) treated persistent right-sided nonsurgical pneumoperitoneum, improvement on day-10, gradual removal five chest drains day-19 extubation day-24. Transillumination radiography were main diagnostic investigations. Laryngotracheobronchoscopy day-16 identified erythema possible old injury the carina. also for hypotension, suspected sepsis pulmonary hypertension discharged home day-66. Identifying promptly essential reduce morbidity mortality. Lung ultrasound would improve diagnosis monitoring. Management patient-specific includes needle HFOV. Use blood patch, fibrin glue or chemical agents, selective bronchial have been reported. Surgery usually applied in unstable patients where bridging defect not feasible. pneumoperitoneum should be considered ventilated neonates those avoid exploratory laparotomy. Our case demonstrates challenges managing massive air leak premature newborn, who adequate HFOV, successfully recovered from presumed conservative management.