Anemia of Prematurity - Portal Neonatal

WORKUP Section 5 of 10
Lab Studies: Blood gases should be obtained to ensure adequate gas exchange.
Imaging Studies:
• Chest radiograph (see Images 1-3)
o The classic radiologic appearance of PIE often provides a clear diagnosis. PIE is best
visualized in the anteroposterior supine projection. PIE has two basic radiographic
appearances, linear and cystlike radiolucencies, although both types often appear
together.
o Linear radiolucencies are coarse and nonbranching, measure from 3-8 mm, and vary in
width but rarely exceed 2 mm.
o Small cystlike radiolucencies extend in diameter from 1-4 mm, and, though generally
round, they may appear oval or slightly lobulated.
o Disorganized haphazard distribution of PIE in localized areas is unlike the anatomically
organized pattern of the air-bronchogram. The air-bronchogram is a classic radiographic
sign of RDS, which should not be confused with PIE. In RDS, long, smooth, branching,
linear radiolucencies decrease in caliber from the hilum and frequently disappear at the
lung periphery. PIE should be suspected when coarse radiolucencies appear in the lung
periphery or when the lucencies do not branch in a pattern consistent with the normal
bronchial tree.
o In some patients receiving mechanical ventilation, distended airways and alveoli have a
somewhat similar appearance to that of PIE on radiographs. Over time, it either
progresses to a classic radiographic picture of PIE or resolves very rapidly as ventilator
settings are decreased.
o PIE rarely can be misinterpreted as normally aerated lung surrounded by exudate as in an
aspiration syndrome or pulmonary edema.
Histologic Findings: The histology of PIE is well described by Plenat et al. Their histologic study
demonstrates interstitial slits preferentially located in perivenous topography. Sometimes, the
peribronchial arterial or arteriolar sheaths are involved. Air dissects through a plane just next to the
arterial or arteriolar face, opposite the bronchus, which is pushed into adjoining parenchyma. The
bronchoarterial solidarity most often is respected. Seldom, air can dissect arterioles and bronchioles
and isolate them from the adjacent lobules. On the periphery of interstitial slits, the small vessels are
compressed but never ruptured, while the collagen fibers constantly are broken and squeezed
together.
TREATMENT Section 6 of 10
Medical Care: Different treatment modalities have been used to manage PIE, with variable success.
• Lateral decubitus positioning
o This conservative approach has been used with success and is most effective in infants
with unilateral PIE. The infant is placed in the lateral decubitus position with the affected
lung in a dependent position. This therapy can result in plugging of dependent airways
and improved oxygenation of the nondependent lung. The latter allows for overall
decreased ventilatory settings. The combination of the above factors helps in resolution of
PIE.
o In different case studies of lateral decubitus position as a treatment of unilateral PIE in
infants, PIE resolved in 48 hours to 6 days with minimal recurrence and a low failure rate.
Lateral decubitus positioning should be considered as an early first-line therapy in the
management of unilateral PIE. Lateral decubitus positioning has been used successfully
for patients with bilateral PIE when one side is affected more significantly.