Ultrasound-guided pleural effusion drainage combined with HFOV in the treatment of a neonatal Staphylococcus aureus pyopneumothorax: a case report

Lung ultrasound (LUS)-guided catheter drainage of pleural effusion has significant advantages in precise positioning and dynamic monitoring for neonates. Although high-frequency oscillatory ventilation (HFOV) has become a mature therapy for severe respiratory failure, the combined use of HFOV support with LUS-guided drainage in neonates with Staphylococcus aureus ( S. aureus ) pyopneumothorax complicated by acute respiratory failure remains relatively rare in clinical reports. The physiological characteristics and clinical manifestations of neonates differ from those of adults and older children. This combination, which uses HFOV to maintain stable alveolar inflation and LUS for accurate positioning, may reduce the risks associated with the procedure and barotrauma. This report aims to explore the effectiveness and safety of this combined treatment regimen, assess its clinical outcomes including short-term resolution and six-month developmental progress of neonates with S. aureus pneumonia complicated by pyopneumothorax and acute respiratory failure. A 10-day-old male infant was admitted to hospital with chief complaints of “crying with throat rales persisting for 17 hours”. The infant exhibited occasional grunting and mild circumoral cyanosis. Rattling sounds were auscultated bilaterally over the lungs. Admission laboratory tests revealed a significant elevation in inflammatory markers. Blood metagenomic next-generation sequencing (mNGS) identified S. aureus as the causative agent. On the 10th hospital day, his dyspnoea worsened suddenly. Despite the administration of high-flow oxygen via a head hood, no improvement was observed. Clinically diagnosed with respiratory failure, the child underwent bedside chest X-ray and LUS, which revealed left pyopneumothorax. HFOV was initiated for respiratory support, alongside ultrasound-guided catheter drainage of pleural effusion. Pleural pus cultures confirmed S. aureus infection. Following a total hospitalisation period of 32 days, re-evaluations showed white blood cell counts, C-reactive protein levels, procalcitonin and interleukin-6 had all returned to normal ranges. The oxygenation index (OI) improved significantly. Chest imaging demonstrated that the lesion had become more localised compared with prior assessments, and the child was discharged following clinical improvement. Post-discharge monitoring over a six-month period confirmed satisfactory physical growth and development. LUS-guided catheter drainage of pleural effusion, performed effectively during HFOV support in the infant, successfully managed a newborn infant with severe S. aureus pneumonia complicated by pyopneumothorax. This synergistic approach, integrating the precision of LUS-guided intervention within the stable respiratory milieu provided by HFOV, warrants clinical consideration.