Persistent acquired lobar overinflation complicating bronchopulmonary dysplasia

Persistent acquired lobar overinflation (PALO) may complicate bronchopulmon ary dysplasia (BPD). From infants admitted to the regional neonatal intensi ve care unit or who had been followed up at the chronic lung disease clinic in Liverpool over a 6.5-year period, 11 children with BPD and PALO were id entified and details of their neonatal and subsequent outcome obtained. The ir median gestational age was 29 weeks (range 24-33) and median birth weigh t was 1317 g (range 676-1968 g). All had received ventilatory support for s evere neonatal respiratory distress syndrome for a median of 26 days (range 5-86). The median age the acquired lobar overinflation was detected was 82 days (range 45-424 days). Nine patients required continued neonatal or pae diatric intensive care re-admission for deteriorating respiratory function. Six children have subsequently died at a median age of 9.5 months (range 6 .5-20). Five patients underwent bronchoscopy, four suggesting the presence of bronchomalacia. Three patients had ventilation-perfusion scans all showi ng that the overinflated lobe had no mismatch defect unlike other areas of the lung. Conclusion The place of specific therapies for persistent acquired lobar ov erinflation is unclear. Surgery to remove the overinflated lobe in such cas es may be inappropriate and the outcome of this complication of bronchopulm onary dysplasia appears to be poor.