Neonatal Pneumothorax: A Descriptive Regional Danish Study

Abstract

Background: Neonatal pneumothorax (PTX) can occur due to underlying pulmonary disease and/or ventilatory support. PTX can also develop at the onset of respiration. PTX can be life-threatening, and prompt diagnosis is essential to reduce mortality. Objective: To analyse aetiology, demographic aspects, age at diagnosis, required treatment (specifically drainage), and prognosis of all cases of neonatal PTX observed in the North Jutland Region of Denmark from 1 January 2006 to 31 December 2014. Method: Retrospective, descriptive, population-based cohort study. Results: During the study period there were 48,968 live births and 71 cases of PTX, giving an incidence of PTX of 0.14% (95% Cl: 0.11-0.18). Of these, 21% were bilateral and 59% tension PTX. Fifty-two percent of neonates affected were born at term. Almost all neonates had underlying lung disease, most commonly transient tachypnea of the newborn (TTN) in 39% and respiratory distress syndrome (RDS) in 42%. Only 3% were considered to have developed PTX at the onset of respiration. In preterm neonates, the median age at diagnosis was 28.5 h (IQR: 18.3-48.6), whereas in infants born at term the median age was 6.1 h (IQR: 1.1-17.2) (p < 0.001). Thirteen percent of PTX infants died. Fifty-nine percent of the infants required drainage of the PTX, more frequently those with RDS than TTN. Conclusion: Almost all infants with PTX had underlying lung disease, divided equally between RDS and TTN. The diagnosis of PTX was made earlier in infants with TTN than RDS. Neonates with RDS required drainage more often than those with TTN.

Yeni̇doğanda Pnömotoraks Ve Göğüs Tüpü İle Drenaj Tedavi̇si̇ Gereksi̇ni̇mi̇ne Göre Demografi̇k Ve Kli̇ni̇k Özelli̇kleri̇n Karşilaştirilmasi

“…In infants who in need drainage, the duration of invasive and noninvasive respiratory support and the time of hospitalization are significantly longer. Pnömotoraks yenidoğan döneminde en sık ilk 3 gün içinde görülmektedir (3,6,20). Bizim çalışmamızda da tüm grupta pnömotoraks gelişme zamanı ortanca 37 (19-43) saatti ve bebeklerin %80.6'sında ilk 48 saat içinde olduğu bulunmuştur.…”

“…Pnömotoraks spontan olarak gelişebilmekle birlikte sıklıkla altta yatan bir primer akciğer hastalığı mevcuttur (1)(2)(3)(4)(5)(6) çalışmasında bulunmasına rağmen, SUPPORT çalışmasında ve geniş bir seride yapılan çalışmada risk artışı saptanmamıştır (24)(25)(26). Çalışmamızda drenaj gereken ve gerekmeyen gruplar arasında pnömotoraks gelişmesi öncesinde MV ve NİSD uygulaması açısından anlamlı fark saptanmaz iken, drenaj gerekmeyen grupta oda havasında veya serbest oksijen alanların oranı anlamlı olarak yüksek bulunmuştur.…”

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

“…Apiliogullari et al reported that aggregate mortality was as high as 30% in PTX patients while survivors also had an increased rate of bronchopulmonary dysplasia (4.28x vs. controls) 9 . Therefore, early and accurate diagnosis followed by adequate treatment is imperative 3,4,5,6,7,8,9,10,11,12,13,14 . Lately, less expensive US imaging systems have become readily available, and non-ionizing, fast, and repeatable LUS represents an ideal tool for the diagnosis of neonatal PTX.…”

Yenidoğanda Pnömotoraks ve Göğüs Tüpü Uygulamaları

“…Pulmoner hava kaçakları olan bebeklerin hava kaçağı olduktan sonraki yaşam sürelerinin ortancası 2 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) gündü. [12] Çalışmamızda 5 gün (1-13) olarak bulunmuştur.…”