Risk factors for pneumothorax in very low birth weight infants*

Klinger, G; Ish-Hurwitz, Shany; Osovsky, Micky; Sirota, Lea; Linder, Nehama

doi:10.1097/pcc.0b013e31816c6e55

Cited by 36 publications

(28 citation statements)

References 17 publications

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“…This great variation may be due to differences in the indication for admission and treatment at a given neonatal department. In agreement with the literature [14,15,16,17,18], the frequency of PTX increased with decreasing GA among neonates admitted to a tertiary neonatal department. …”

Section: Discussionsupporting

confidence: 80%

Neonatal Pneumothorax: A Descriptive Regional Danish Study

Vibede

Bendtsen

et al. 2016

Neonatology

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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.

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Section: Discussionsupporting

confidence: 80%

Neonatal Pneumothorax: A Descriptive Regional Danish Study

Vibede

Bendtsen

et al. 2016

Neonatology

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“…In a case-control study of very low birth weight infants from 1997 to 2002, pneumothorax developed in 10.9% of infants. Multivariate analysis showed that maximal peak inspiratory pressures during the 24 hours before diagnosis (odds ratio [OR], 2.84; CI, 1.6-5.4) and the number of suction procedures during the 8 hours before diagnosis (OR, 1.56; CI 1.09-2.23) were both independently associated with pneumothorax [41]. Other studies that included both ventilated preterm and term infants in the analysis identified low birth weight (OR, 19.3; CI 2.3-160.2), the administration of bag and mask ventilation (OR, 29; CI 3.6-233.5), endotracheal tube displacement (64% in infants with air leaks versus 18.5% in controls, P!.05), and an increase in clinical interventions including suction procedures, chest radiography, reintubation, and chest compressions as variables associated with pneumothorax [42][43][44].…”

Section: Air Leak Syndromesmentioning

confidence: 97%

Pulmonary Complications of Mechanical Ventilation in Neonates

Miller¹,

Carlo²

2008

Clinics in Perinatology

127

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“…This improved control, through a reduction in volutrauma and barotrauma, can reduce the incidence of pneumothoraces8 9 and bronchopulmonary dysplasia 10 11 12. We have equipped our entire tertiary neonatal unit, labour ward and postnatal wards with Neopuff T-piece resuscitators, following extensive staff training in the use of this device.…”

mentioning

confidence: 99%

Potential hazard of the Neopuff T-piece resuscitator in the absence of flow limitation

Hawkes

Oni

Dempsey

et al. 2009

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objective: (1) To assess peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP) and maximum pressure relief (P max ) at different rates of gas flow, when the Neopuff had been set to function at 5 l/min. (2) To assess maximum PIP and PEEP at a flow rate of 10 l/min with a simulated air leak of 50%. Design: 5 Neopuffs were set to a PIP of 20, PEEP of 5 and P max of 30 cm H 2 O at a gas flow of 5 l/min. PIP, PEEP and P max were recorded at flow rates of 10, 15 l/min and maximum flow. Maximum achievable pressures at 10 l/ min gas flow, with a 50% air leak, were measured. Results: At gas flow of 15 l/min, mean PEEP increased to 20 (95% CI 20 to 21), PIP to 28 (95% CI 28 to 29) and the P max to 40 cm H 2 O (95% CI 38 to 42). At maximum flow (85 l/min) a PEEP of 71 (95% CI 51 to 91) and PIP of 92 cm H 2 O (95% CI 69 to 115) were generated. At 10 l/ min flow, with an air leak of 50%, the maximum PEEP and PIP were 21 (95% CI 19 to 23) and 69 cm H 2 O (95% CI 66 to 71). Conclusions: The maximum pressure relief valve is overridden by increasing the rate of gas flow and potentially harmful PIP and PEEP can be generated. Even in the presence of a 50% gas leak, more than adequate pressures can be provided at 10 l/min gas flow. We recommend the limitation of gas flow to a rate of 10 l/min as an added safety mechanism for this device.

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Risk factors for pneumothorax in very low birth weight infants*

Cited by 36 publications

References 17 publications

Neonatal Pneumothorax: A Descriptive Regional Danish Study

Neonatal Pneumothorax: A Descriptive Regional Danish Study

Pulmonary Complications of Mechanical Ventilation in Neonates

Potential hazard of the Neopuff T-piece resuscitator in the absence of flow limitation

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