Background: Pneumothorax is common complication in newborns; its incidence is increased by intubation, particularly when high pressure ventilation is necessary. Systemic air embolism is a rare and usually fatal form of "displaced air".
Case report: A preterm newborn, 27 weeks of gestational age, weighing 940 g, with respiratory distress syndrome was treated by intubation at 1 min of life and high pressure ventilation (Peak 36 cmH2O, PEP 6 cmH2O, FiO2 = 1). Bilateral pulmonary interstitial emphysema was seen on X-rays at 4 hr of life. Acute cyanosis and bradycardia occurred at 7 hr of life; large amounts of air mixed with blood were withdrawn from the umbilical vein catheter. There was no pneumothorax, pneumomediastinum or subcutaneous emphysema. The newborn died at 9 hr of life. Post mortem injection of contrast fluid into umbilical vein catheter indicated no cardiac perforation: this finding was confirmed by autopsy.
Conclusion: This is a new case of systemic air embolism that may be due to high pressure ventilation in an extremely underweight newborn. Preventive measures consist of monitoring ventilation, possibly using new techniques, but their efficacy remain to be demonstrated.