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Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate
  1. Alicia Iglesias-Deus1,
  2. Alejandro Pérez-Muñuzuri1,
  3. Olalla López-Suárez1,
  4. Pilar Crespo2,
  5. Maria-Luz Couce1
  1. 1Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
  2. 2Neonatal Unit, Department of Pediatrics, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
  1. Correspondence to Dr Alicia Iglesias Deus, Neonatal Unit, Department of Pediatrics, Santiago de Compostela University Hospital, Travesía Choupana, s/n, Santiago de Compostela 15706, Spain; Alicia.Iglesias.Deus{at}


The use of high-flow nasal cannula (HFNC) therapy as respiratory support for preterm infants has increased rapidly worldwide. The evidence available for the use of HFNC is as an alternative to nasal continuous positive airway pressure (CPAP) and in particular to prevent postextubation failure. We report a case of tension pneumocephalus in a preterm infant as a complication during HFNC ventilation. Significant neurological impairment was detected and support was eventually withdrawn. Few cases of pneumocephalus as a complication of positive airway pressure have been reported in the neonatal period, and they all have been related to CPAP. This report reinforces the need to be aware of this rare but possible complication during HFNC therapy, as timely diagnosis and treatment can prevent neurological sequelae. We also stress the importance of paying close attention to flow rate, nasal cannula size and insertion, and mouth position, and of regularly checking insertion depth.

  • Cranial cavity
  • Air
  • Positive pressure ventilation
  • Non-invasive ventilation
  • Newborn

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  • Contributors AI-D took part in patient management, data collection, a critical review of the literature and drafting of the manuscript; AP-M took part in patient management, a critical review of the literature and revision of the manuscript; OL-S and PC took part in patient management; PC, the guarantor of the article, took part in patient management, a critical review of the literature review and manuscript revision. All the authors approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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