Systemic Corticosteroids in Refractory Pulmonary Interstitial Emphysema: A Case Report in a Preterm Infant

¹Department of Paediatrics and Neonatology, Kidz Health Castle Universitair Ziekenhuis Brussel, Brussels, Belgium

²Department of Neonatology, Universitair Ziekenhuis Brussel, Brussels, Belgium

³Department of Pediatrics, subdivision of Neonatology, Curacao Medical Center, Willemstad, Curacao

*Corresponding author: Ines Johri, Department of Paediatrics and Neonatology, Kidz Health Castle Universitair Ziekenhuis Brussel, UZ Brussel Brussels Health Campus Laarbeeklaan 101 1090 Jette, Brussels, Belgium, Phone: +32486084725, E-mails: [email protected]; [email protected]

Received Date: August 15, 2025

Published Date: November 10, 2025

Citation: Johri I, et al. (2025). Systemic Corticosteroids in Refractory Pulmonary Interstitial Emphysema: A Case Report in a Preterm Infant. Neonatal. 6(2):27.

Copyrights: Johri I, et al. © (2025).

ABSTRACT

Background: Pulmonary interstitial emphysema (PIE) is characterized by alveolar and airway overdistension with rupture into the interstitial space, forming cystic air collections. It occurs predominantly in preterm infants with neonatal respiratory distress syndrome (nRDS) requiring mechanical ventilation. Case presentation: We report a male infant born at 27 4/7 weeks, who developed severe bilateral PIE in the first days of life. Conservative management, including lung-protective ventilation and lateral positioning, failed. On day of life (DOL) 11, systemic dexamethasone was initiated (starting dose 0.3 mg/kg/day). Progressive clinical and radiographic improvement was observed, with successful extubation on DOL 15 and sustained weaning on non-invasive support. The total dexamethasone course lasted 22 days, with a cumulative dose of 3.15 mg/kg. The infant was discharged home on DOL 90 with supplemental oxygen, discontinued at 8 months. At the most recent follow-up (22 months corrected age), he shows good growth favorable psychomotor development. Conclusion: This case highlights the potential role of systemic corticosteroids in refractory PIE. By reducing airway inflammation, edema and interstitial air trapping, steroids may facilitate extubation and recovery. However, the optimal regimen and long-term safety remain uncertain. Corticosteroid therapy should be considered in severe PIE unresponsive to conservative measures, while further research is needed to define best practices.

Keywords: Pulmonary Interstitial Emphysema, Pregnancy, Lung Damage, Cytokines