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Atelectasis in Infants

Definition

Atelectasis is a collapse in part of the lungs. Normally, air passes through the airways into small sacs of the lungs. Oxygen from the air passes through these sacs into the blood. Carbon dioxide also passes from the blood to the sacs to leave the body. With atelectasis, these sacs are collapsed. Oxygen and carbon dioxide cannot pass through the collapsed sacs.

A collapse over large areas of the lungs can lead to serious problems. In infants, atelectasis may be:

  • Congenital—present at birth
  • Acquired—caused by an acquired condition

Healthy Lungs

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Causes    TOP

Atelectasis is not a disease. It is the result of a disease or abnormality in the body. It can be caused by:

  • Blockage in airways—as a result of an inhaled stool during birth, inhaled object, or a mucus plug that keeps air from moving into sacs
  • Lung infections—may cause fluid build-up that blocks air to lung sacs
  • Lack of surfactant (common in premature infants)—surfactant is a fluid that lines the inside of the lungs and helps them function properly
  • Impaired breathing—air is not pulled deep enough into the lungs to open all sacs
  • Damage to nerve and muscles that control breathing—may prevent coughing, deep breathing, or yawning

Risk Factors    TOP

Factors that increase the chance of congenital atelectasis include:

  • Inhaled meconium or amniotic fluid
  • Prolonged or difficult labor
  • Birth injury to central nervous system

Children under 3 years old are more likely to develop atelectasis than older children or adults. Factors that may increase your baby’s chance of atelectasis include:

  • Premature birth
  • Lung condition or infection—particularly if coughing is impaired
  • Injury to chest wall
  • Having anesthesia
  • Inhaling a foreign object, such as a peanut or marble
  • Respiratory distress syndrome
  • Being on ventilator—air does not move into lungs in a normal pattern

Symptoms    TOP

Atelectasis may not have obvious symptoms.

Larger areas of atelectasis may lead to:

  • Rapid breathing
  • Taking shallow breaths
  • Agitation
  • Coughing
  • Decreased chest movement during breathing
  • Wheezing
  • Fever
  • Blueness of the skin

Diagnosis    TOP

The doctor will ask about your child’s symptoms and medical history and perform a physical exam. The doctor will listen to breath sounds. To confirm atelectasis your doctor will need detailed pictures of the lungs. This may be done with:

A bronchoscopy may be done if an obstruction is a possibility. This is an exam of the lungs, done with a small tube.

Treatment    TOP

Treatment will be based on the cause of the atelectasis. Some oxygen or breathing support may also be needed until the problem resolves. Treatment options include:

Removing Blockage

Your doctor will take steps to remove any blockage that is causing the problem.

A bronchoscopy may be done to remove an inhaled object. A thin tube-shaped tool called a bronchoscope is used. It is passed down the throat and into the lungs. The doctor can pass small tools through the bronchoscope to remove the object.

A bronchoscopy may also be done to remove a mucus plug.

Physical Therapy

Chest therapy can be used to help move mucus out of the lungs. There are a few different types that may be used. One option uses a rhythmic tapping on the back and chest. Certain positions will also use gravity to help mucus flow out of the body. Your baby may be placed in special positions to help move mucus out of the lungs.

Respiratory Therapy    TOP

This may include any or all of the following:

  • Breathing masks or treatments to help keep airways open
  • Suction to help remove secretions
  • Breathing support with ventilator—to take over or assist breathing until your baby is better

Medication    TOP

Medications may help to improve breathing or treat the underlying condition. Medications may help to:

  • Open the airways
  • Treat the disease that caused the collapse
  • Treat an infection (antibiotics)

Oxygen may be needed to support your baby while he/she recovers.

Prevention    TOP

Not all atelectasis can be prevented. To help reduce your baby’s chance of atelectasis, take these steps:

  • Be careful with small objects around infants
  • Work with your doctor to treat or manage any lung conditions your baby has
  • Take steps to avoid premature birth such as:
    • Get regular prenatal care
    • During pregnancy, eat a well-balanced diet with plenty of fruits and vegetables
    • Get adequate activity

Some medical conditions or treatments increase your baby’s risk of atelectasis. Your doctor will take certain steps to prevent atelectasis such as:

  • Medication to improve surfactant in premature babies
  • Treating and monitoring lung infections
  • Careful management of necessary oxygen or breathing therapy in infants

RESOURCES:

American Lung Association
http://www.lung.org
Nemours Kids Health
http://kidshealth.org

CANADIAN RESOURCES:

The Lung Association
http://www.lung.ca

References:

Braverman M, Brown S. Congenital Atelectasis Discussion and Case Presentation. Radiology . December 2012, 265(3);1144. Available at: http://radiology.r... . Accessed December 7, 2012.
Collapsed lung (atelectasis). Cedars-Sinai website. Available at: http://www.cedars-... . Accessed December 7, 2012.
What is atelectasis? National Heart Lung and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/atl . Accessed December 6, 2012.
Last reviewed September 2013 by Kari Kassir, MD
Last Updated: 9/30/2013