Neonatal Med.  2022 Feb;29(1):18-27. 10.5385/nm.2022.29.1.18.

Neonatal Pneumothorax in Late Preterm and Full-Term Newborns with respiratory Distress: A Single-Center Experience

• Kim EA
• Jung JH
• Lee SY
• Park SH
• Kim JS

• KMID: 2527257
• DOI: http://doi.org/10.5385/nm.2022.29.1.18

Abstract

Purpose
To evaluate the incidence rate, clinical characteristics, and perinatal outcomes of pneumothorax in late preterm and full-term newborns with respiratory distress and analyze the risk factors associated with pneumothorax.
Methods
Infants born at ≥34 weeks’ gestation with respiratory distress and pneumothorax admitted between February 2014 and December 2020 were enrolled in this study. The pneumothorax group (n=36) was matched to the control group (n=144) in a 1:4 ratio, based on gestational age and birth weight. Risk factors were identified using logistic regression analysis with backward stepwise selection.
Results
The incidence of pneumothorax during the study period was 1.36% (38/2,788). All patients were diagnosed with pneumothorax within 48 hours after birth, and increased oxygen demand was the most common symptom. The proportion of mortality and perinatal morbidity, such as intraventricular hemorrhage ≥grade 3, was significantly higher in the pneumothorax group than in the control group. The risk factors associated with pneumothorax were the need for positive pressure ventilation in the delivery room (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.26 to 9.12; P=0.015) and a higher fraction of inspired oxygen to achieve an oxygen saturation of ≥90% on admission (OR, 1.06; 95% CI, 1.03 to 1.09; P<0.001).
Conclusion
Pneumothorax should be suspected in late preterm and full-term newborns with respiratory distress within the first 3 days of life. Based on these risk factors, early diagnosis can reduce perinatal mortality and morbidity.

Keyword

Infant, newborn; Pneumothorax; Epidemiology; Risk factors

Reference

1. Smith J, Schumacher RE, Donn SM, Sarkar S. Clinical course of symptomatic spontaneous pneumothorax in term and late preterm newborns: report from a large cohort. Am J Perinatol. 2011; 28:163–8.

2. Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: trends, predictors and outcomes. J Neonatal Perinatal Med. 2014; 7:29–38.

3. Kitsommart R, Martins B, Bottino MN, Sant'Anna GM. Expectant management of pneumothorax in preterm infants receiving assisted ventilation: report of 4 cases and review of the literature. Respir Care. 2012; 57:789–93.

4. Trevisanuto D, Doglioni N, Ferrarese P, Vedovato S, Cosmi E, Zanardo V. Neonatal pneumothorax: comparison between neonatal transfers and inborn infants. J Perinat Med. 2005; 33:449–54.

5. Hill A, Perlman JM, Volpe JJ. Relationship of pneumothorax to occurrence of intraventricular hemorrhage in the premature newborn. Pediatrics. 1982; 69:144–9.

6. Landry JS, Menzies D. Occurrence and severity of bronchopulmonary dysplasia and respiratory distress syndrome after a preterm birth. Paediatr Child Health. 2011; 16:399–403.

7. Ozer EA, Ergin AY, Sutcuoglu S, Ozturk C, Yurtseven A. Is pneumothorax size on chest x-ray a predictor of neonatal mortality? Iran J Pediatr. 2013; 23:541–5.

8. El-Masry H, Aladawy MA, Sayed Younis MM, Mahmoud DH. Risk factors for pneumothorax in ventilated neonates admitted to neonatal intensive care unit (NICU). Ann Neonatol J. 2021; 3:70–87.

9. Terzic S, Heljic S, Panic J, Sadikovic M, Maksic H. Pneumothorax in premature infants with respiratory distress syndrome: focus on risk factors. J Pediatr Neonatal Individ Med. 2016; 5:e050124.

10. Girard I, Sommer C, Dahan S, Mitanchez D, Morville P. Risk factors for developing pneumothorax in full-term neonates with respiratory distress. Arch Pediatr. 2012; 19:368–73.

11. Zarogoulidis P, Kioumis I, Pitsiou G, Porpodis K, Lampaki S, Papaiwannou A, et al. Pneumothorax: from definition to diagnosis and treatment. J Thorac Dis. 2014; 6(Suppl 4):S372–6.

12. Lee AC, Panchal P, Folger L, Whelan H, Whelan R, Rosner B, et al. Diagnostic accuracy of neonatal assessment for gestational age determination: a systematic review. Pediatrics. 2017; 140:e20171423.

13. Schlaudecker EP, Munoz FM, Bardaji A, Boghossian NS, Khalil A, Mousa H, et al. Small for gestational age: case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine. 2017; 35(48 Pt A):6518–28.

14. Dubil EA, Magann EF. Amniotic fluid as a vital sign for fetal wellbeing. Australas J Ultrasound Med. 2013; 16:62–70.

15. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92:529–34.

16. Thebaud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH, et al. Bronchopulmonary dysplasia. Nat Rev Dis Primers. 2019; 5:78.

17. Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res. 2020; 88(Suppl 1):10–5.

18. Silva IS, Flor-de-Lima F, Rocha G, Alves I, Guimaraes H. Pneumothorax in neonates: a level III neonatal intensive care unit experience. J Pediatr Neonatal Individ Med. 2016; 5:e050220.

19. Kim Y, Lee E. Pneumothorax in full-term neonates transferred due to respiratory distress. Perinatology. 2019; 30:140–6.

20. Hadzic D, Skokic F, Husaric E, Alihodzic H, Softic D, Kovacevic D. Risk factors and outcome of neonatal pneumothorax in Tuzla Canton. Mater Sociomed. 2019; 31:66–70.

21. Walker MW, Shoemaker M, Riddle K, Crane MM, Clark R. Clinical process improvement: reduction of pneumothorax and mortality in high-risk preterm infants. J Perinatol. 2002; 22:641–5.

22. Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal pneumothorax: a descriptive regional danish study. Neonatology. 2017; 111:303–8.

23. Zanardo V, Padovani E, Pittini C, Doglioni N, Ferrante A, Trevisanuto D. The influence of timing of elective cesarean section on risk of neonatal pneumothorax. J Pediatr. 2007; 150:252–5.

24. Andersson J, Magnuson A, Ohlin A. Neonatal pneumothorax: symptoms, signs and timing of onset in the post-surfactant era. J Matern Fetal Neonatal Med. 2021; Feb. 3. [Epub]. https://doi.org/10.1080/14767058.2021.1882981.

25. Okumus M, Zubarioglu AU. Neonatal pneumothorax: 10 years of experience from a single center. J Pediatr Res. 2020; 7:163–7.

26. Apiliogullari B, Sunam GS, Ceran S, Koc H. Evaluation of neonatal pneumothorax. J Int Med Res. 2011; 39:2436–40.

27. Bhatia R, Davis PG, Doyle LW, Wong C, Morley CJ. Identification of pneumothorax in very preterm infants. J Pediatr. 2011; 159:115–20.

28. Karlberg P, Cherry BR, Escardo FE, Koc G. Respiratory studies in newborn infants. II: Pulmonary ventilation and mechanics of breathing in the first minutes of life, including the onset of respiration. Acta Paediatr. 1962; 51:121–36.

29. Bhat Yellanthoor R, Ramdas V. Frequency and intensive care related risk factors of pneumothorax in ventilated neonates. Pulm Med. 2014; 2014:727323.

30. Navaei F, Aliabadi B, Moghtaderi M, Kelishadi R. Predisposing factors, incidence and mortality of pneumothorax in a neonatal intensive care unit in Isfahan, Iran. Zhongguo Dang Dai Er Ke Za Zhi. 2010; 12:417–20.

31. Watkinson M, Tiron I. Events before the diagnosis of a pneumothorax in ventilated neonates. Arch Dis Child Fetal Neonatal Ed. 2001; 85:F201–3.

32. Hishikawa K, Goishi K, Fujiwara T, Kaneshige M, Ito Y, Sago H. Pulmonary air leak associated with CPAP at term birth resuscitation. Arch Dis Child Fetal Neonatal Ed. 2015; 100:F382–7.

33. Smithhart W, Wyckoff MH, Kapadia V, Jaleel M, Kakkilaya V, Brown LS, et al. Delivery room continuous positive airway pressure and pneumothorax. Pediatrics. 2019; 144:e20190756.

34. Niwas R, Nadroo AM, Sutija VG, Gudavalli M, Narula P. Malposition of endotracheal tube: association with pneumothorax in ventilated neonates. Arch Dis Child Fetal Neonatal Ed. 2007; 92:F233–4.

35. Ngerncham S, Kittiratsatcha P, Pacharn P. Risk factors of pneumothorax during the first 24 hours of life. J Med Assoc Thai. 2005; 88 Suppl 8:S135–41.