Surgical treatment for pulmonary interstitial emphysema (PIE) has been reported with increasing frequency. We have done pulmonary lobectomies in 14 neonates with the localized form of PIE. This type of treatment was successful in 11 patients. Two patients expired in the hospital and one showed no improvement. Another six very compromised patients with diffuse PIE were treated during the same period with multiple visceral pleurotomies. Only one survived. Infants with diffuse PIE are usually poor surgical candidates, while those with acquired lobar emphysema (ALE) have been treated successfully with lobectomies.