Can neonatal pneumothorax be successfully managed in regional Australia?

Abstract

Introduction: There is a lack of data reflecting the trend ofneonatal pneumothorax in regional Australia. The aim of this studyis to review the incidence and characteristics of neonatesdiagnosed with pneumothorax in Central Queensland, analyseoutcomes in terms of the ability of local hospitals to manage thiscondition, and describe predictors for severe disease requiringtransfer to a tertiary centre. Thus the role of regional healthservices in managing this condition will be reviewed. Methods: This was a retrospective observational study of allneonates born between 1 January 2008 and 31 December 2015coded by hospital records with a diagnosis of neonatalpneumothorax in Central Queensland. Data for sex and birthRural and Remote Health rrh.org.auJames Cook University ISSN 1445-6354gestation for all Central Queensland births of the same periodwere also obtained. Descriptive statistics were calculated for birthweight and gestation, and Apgar scores. Frequencies werecalculated for sex, length of admission, age of diagnosis and riskfactors including meconium aspiration syndrome (MAS),prolonged rupture of membranes (PROM) and positive pressureventilation (PPV). The primary outcome measure was successfultreatment at a Central Queensland hospital versus requirement fortransfer to tertiary hospital or death prior to transfer. Statisticalsignificance was calculated for binary and continuous variables. Results: During the study period, there were 31 cases ofpneumothorax amongst 17640 deliveries recorded by threeCentral Queensland hospitals, with a significant bias towards males(84%) amongst pneumothorax cases (p<0.001). Median gestationalage was comparable between the Central Queensland populationand the pneumothorax cohort. Diagnosis of pneumothorax wasusually made within 48 hours of birth (87.1%). PPV was present intwo-thirds of the pneumothorax cohort whilst MAS and PROMwere less common. No significant relationship was found betweentype of pneumothorax and gender, birth weight, MAS, PROM, caesarean section or PPV. The majority of cases were successfullytreated locally (67.7%) and with oxygen alone (64.5%). Othertreatment modalities included surfactant use, thoracocentesis, chest tube insertion and PPV. Patients with bilateral pneumothoraxor pneumomediastinum had poorer outcomes (p=0.04). Overalllocal outcomes were good, with only one perinatal death prior to discharge or transfer. Conclusion: Neonatal pneumothorax is effectively managed inthe regional hospitals studied in keeping with contributions ofregional paediatricians and rural generalists. Compared withunilateral pneumothorax, bilateral pneumothorax orpneumomediastinum were associated with transfer to tertiarycentre. There were no clear predictors for bilateral pneumothorax.