Neonatal pneumothorax - 10 years of experience from a single center

Abstract

Aim: Pneumothorax is detected in approximately 1-2% of all term newborns and this rate can reach 15-20% in neonatal intensive care unit (NICU)'s; tube thoracostomy (TT) is the traditional treatment in symptomatic newborns. The management of neonatal pneumothorax, and etiologies, and risk factors related to mortality were evaluated in this study. Materials and Methods: A total of 6.647 newborns who were treated in the NICU during the last ten years were evaluated retrospectively. Newborns with pneumothorax were included in the study. Demographic characteristics, treatment modalities, and outcomes were evaluated. Results: Pneumothorax was diagnosed in 124 (1.9%) newborns. The mean gestational age was 33.3±5.1 weeks and the mean birth weight was 2,163.7±899.4 grams; 101 (81%) were preterm and 40 (32%) were very low birth weight newborns. Seventy-four (58%) newborns were diagnosed as having Respiratory Distress syndrome, the diagnosis was transient tachypnea of the newborn in 43 (35%), Meconium Aspiration syndrome in 3 (2.5%) and pneumonia in 4 (3%). One hundred nineteen newborns were treated with TT. Spontaneous resolution was observed in five newborns with close follow-up. A total of 129 (bilateral pneumothorax in 20 newborns) tube thoracostomies were performed at the bedside with no major complication. The overall mortality rate was found to be 21%. Gestational ages were 33 weeks or less in 25 of the 26 deaths. Conclusion: Very low birth weight and prematurity in neonatal pneumothorax are associated with mechanical ventilation necessity and mortality. TT with small-bore chest drains is safe and effective in the management.