Pulmonary air leaks include urgent life-threatening neonatal emergencies like pulmonary interstitial emphysema (PIE), pneumomediastinum, pneumothorax (PT), or pneumopericardium.1 4 The incidence of pulmonary air leaks in the neonates has increased in recent years, possibly because an increasing number of sick infants with respiratory distress on assisted ventilation are now surviving to develop this complication.5 The sequence of events in the occurrence of pulmonary air leaks is similar regardless of whether it is caused by uneven alveolar ventilation, air trapping, and high transpulmonary pressure swings. The rupture of terminal air sacs causes air to escape into the pulmonary interstitium, resulting in pulmonary interstitial emphysema. The air tracks along the sheaths of pulmonary blood vessels to the lung hilum and air may then rupture into mediastinum, pleura, or pericardium.6 It has also been suggested that air directly enters the pleural cavity following a rupture of a subpleural bleb.7 Rarely systemic air embolism may be a terminal event of pulmonary air leaks.