Neonatal Pneumothorax Outcome in Preterm and Term Newborns

Abstract

Background and Objectives: Pneumothorax implies the presence of air in the pleural space between the visceral and parietal pleura. The aim of this study was to investigate the incidence, clinical characteristics, risk factors, therapy and perinatal outcome in neonates with pneumothorax in a tertiary care center. Materials and Methods: A retrospective study based on a five-year data sample of neonates with pneumothorax was conducted in a Maternity Hospital with a tertiary NICU from 2015 to 2020. We included all neonates with pneumothorax born in our hospital and compared demographic characteristics, perinatal risk factors, anthropometric parameters, comorbidities, clinical course and method of chest drainage between term (≥37 GW) and preterm (<37 GW) neonates. Results: The study included 74 newborns with pneumothorax, of which 67.6% were male and 32.5% were female. The majority of women (59.5%) had no complications during pregnancy. Delivery was mainly performed via CS (68.9%). Delivery occurred on average in 34.62 ± 4.03 GW. Significantly more (p = 0.001) children with pneumothorax were born prematurely (n = 53; 71.6%) than at term (n = 21; 28.4%). Most of the neonates had to be treated with ATD (63.5%) and nCPAP (39.2%), but less often they were treated with surfactant (40.5%) and corticosteroids (35.1%). O2 therapy lasted an average of 8.89 ± 4.57 days. Significantly more (p = 0.001) neonates with pneumothorax had additional complications, pneumonia, sepsis, convulsions and intraventricular hemorrhage (68.9%). However, most children had a good outcome (83.8%) and were discharged from the clinic. Fatal outcomes occurred in six cases, while another six neonates had to be transferred to referral neonatal centers for further treatment and care. Conclusion: Significantly more children with pneumothorax were born prematurely than at term. With adequate therapy, even premature newborns can successfully recover from pneumothorax.

Differences in Possible Risk Factors, Treatment Strategies, and Outcomes of Neonatal Pneumothorax in Preterm and Term Infants

“…Although the risk of developing NP is high in premature infants who need resuscitation or who are exposed to IMV due to underlying respiratory problems, the incidence of primary NP in premature infants is also high. 9 , 16 In newborn infants, prematurity and RDS are the most common possible risk factors for NP. 5 According to the study conducted by Joshi et al, 7 50.1% of their study population consisted of preterm infants.…”

“… 5 - 7 On the other hand, secondary pneumothorax is defined as the pneumothorax that occurs due to traumatic injury to the pleura or risk factors such as meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), congenital pneumonia, transient tachypnea of the newborn (TTN), surfactant treatment, endotracheal suctioning, pulmonary hypoplasia, or congenital lung malformations, and the use of positive pressure ventilation (PPV) during resuscitation. 7 - 9 Respiratory distress syndrome was found to be the most common possible underlying lung disease of NP for preterm infants and TTN for term infants. 3 …”

“…There are mainly 3 options for the management of NP: (1) conservative treatment by giving only oxygen; (2) drainage with needle aspiration (NA) by temporary insertion of a needle into the pleural space; or (3) definitive drainage of the air by insertion of a chest drainage catheter (intercostal) into the pleural space. 9 , 10 The oxygen therapy is affected by nitrogen washout. Nitrogen flushing is thought to help resolve pneumothorax by increasing the nitrogen absorption gradient from the extrapulmonary space.…”

“…Although there are numerous studies in the literature on NP risk factors, especially in extremely preterm and term infants, studies comparing NP treatment strategies between preterm and term infants are very limited. 9 , 10 , 13 …”

Evaluation of Respiratory Support Methods and Characteristics of Pneumothorax in Late Preterm and Term Newborns within the First 48 hours of Life

“…Male gender and cesarian delivery were identified as risk factors for pneumothorax development in most studies, which was confirmed in our study. 3,5,[27][28][29][30][31][32][33][34] Studies report that 51 to 77% of pneumothorax involve the right lung 3,5,31,32,34 and 11 to 24% are bilateral. 5,[30][31][32][33] Consistent with these studies, 65% of our patients had a right pneumothorax, and 25% had a bilateral pneumothorax.…”