What is the prevalence of pulmonary interstitial emphysema (PIE) in the US?

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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The prevalence of pulmonary interstitial emphysema (PIE) widely varies with the population studied. In a report by Gaylord et al, PIE developed in 3% of infants admitted to the neonatal intensive care unit (NICU). [20]

In a retrospective case-controlled study, 11 (24%) of 45 extremely low birth weight infants developed PIE. [18] This study was done in the present era of tocolysis, antenatal steroids, and postnatal surfactant administration; however, all infants included in the study were treated with a conventional ventilator in the assist-control mode before the onset of PIE.

The reported incidence of PIE in published clinical trials can be useful. In a randomized trial of surfactant replacement therapy at birth in premature infants born at 25-29 weeks' gestation, Kendig et al reported PIE in 8 (26%) of 31 control neonates, and in 5 (15%) of 34 surfactant-treated neonates. [21]

Another randomized controlled trial of prophylaxis versus treatment with bovine surfactant in neonates with respiratory distress syndrome (RDS) born at less than 30 weeks' gestation included 2 (3%) of 62 early surfactant-treated neonates, 5 (8%) of 60 late surfactant-treated neonates, and 15 (25%) of 60 control neonates with PIE. [22]

Kattwinkel et al compared prophylactic surfactant administration versus the early treatment of RDS with calf lung surfactant in neonates born at 29-32 weeks' gestation; 3 of 627 neonates in the prophylaxis group and 3 of 621 neonates in the early treatment group developed PIE. [23]  This information suggests a higher incidence of PIE in more immature infants as well as those administered with late surfactant therapy.

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