Air leak syndromes include pulmonary interstitial emphysema, pneumomediastinum, pneumothorax, pneumopericardium, pneumoperitoneum, subcutaneous emphysema and systemic air embolism. These syndromes are more common and severe among neonates with underlying lung disease, especially those with low birth weight and respiratory distress syndrome. Antenatal steroids and early surfactant administration can prevent and improve their outcome.
In the case reported, pneumopericardium was the first air leak presentation. Pericardial drainage was postponed due to cardiorespiratory stability on aminergic support. Air dissection into the pleural space led to tension pneumothorax, with gradual clinical improvement after thoracocentesis and chest tube placement. The thoracic drain was removed after 3 days with elective extubation on the 7th day of life. She was discharged home at 36 weeks of postmenstrual age without any respiratory dysfunction.