Infant With Severe Lung Immaturity and Pulmonary Hypertension Is Thriving

Baby Boy P was born at 27 weeks gestational age with a birthweight of just under 1.5 pounds. During his initial weeks of life, he faced many significant health challenges. As a result of severe lung immaturity and pulmonary hypertension, Baby P remained dependent on ventilator support. He developed a large pneumatocele of his right lung, which made managing his respiratory issues even more challenging.

In the setting of worsening respiratory failure, doctors at Baby P’s birth hospital reached out for help from Mount Sinai’s Chronic Lung Care Team, led by Courtney Juliano, MD, Associate Professor of Pediatrics and System Chief of Newborn Medicine, and Douglas Bush, MD, Associate Professor of Pediatrics (Pulmonology), Icahn School of Medicine at Mount Sinai.

At six weeks of age, Baby P was transferred to the Jo Carole and Ronald S. Lauder Neonatal Intensive Care Unit (NICU) at Mount Sinai Kravis Children’s Hospital. There he was cared for by the multidisciplinary Chronic Lung Care Team, which includes neonatologists, pediatric pulmonologists, practitioners, and therapists, all with expertise in managing severe lung disease. It soon became clear that the pneumatocele, which occupied almost the entirety of Baby P’s right lower lung, was becoming life-threatening. Multiple therapeutic options were discussed, and ultimately, the decision was made in consultation with the pediatric surgical team to place a drain in the pneumatocele to remove the air that was pushing on the rest of his lung.

Over the course of weeks, Baby P stabilized, his pneumatocele became smaller and ultimately resolved, and his chest tube was removed. Unfortunately, his respiratory challenges were not over. Due to the severity of his ongoing lung disease and pulmonary hypertension, Baby P required longer-term ventilator support. He underwent tracheostomy placement and entered the chronic phase of his respiratory journey. Under the care of the Chronic Lung Care team, he was successfully moved to a home ventilator. His pulmonary hypertensive medications were adjusted to oral medications, marking a milestone in his recovery. After almost one year of hospitalization, he was successfully transferred to a rehabilitation facility.

As of winter 2024, Baby P continued to be followed by the Chronic Lung Care team at Mount Sinai Kravis Children’s Hospital, who help to manage his ventilator support and respiratory medications. He is currently thriving, no longer requires a mechanical ventilator, and a plan is moving forward to remove his tracheostomy tube.