Pneumothorax in Full-term Neonates Transferred due to Respiratory Distress

Younghyun Kim; Eunsil Lee

doi:10.14734/PN.2019.30.3.140

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Kim and Lee: Pneumothorax in Full-term Neonates Transferred due to Respiratory Distress

Original Article

Perinatology 2019;30(3):140-146.

Published online: 20 September 2019

DOI: https://doi.org/10.14734/PN.2019.30.3.140

Pneumothorax in Full-term Neonates Transferred due to Respiratory Distress

Younghyun Kim, MD, Eunsil Lee, MD, PhD

Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea

Correspondence to Eunsil Lee, MD, PhD Department of Pediatrics, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3485 Fax: +82-53-628-8046 E-mail: les2055@ynu.ac.kr

Received 18 March 2019 Revised 10 June 2019 Accepted 15 June 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To investigate the incidence and course of pneumothorax in full-term infants with dyspnea.

Methods

We retrospectively reviewed 607 newborn infants who had dyspnea and transferred to the tertiary medical center within 24 hours after birth, from 2011 to 2017.

Results

Among the total 607 patients, 74 were excluded. Of the 533 patients, 72 (13.5%) diagnosed pneumothorax by first chest X-ray were in the pneumothorax group and 461 (86.5%) were in the con trol group. The incidence of pneumothorax was 13.5% (72/533) and 7.1% (35/496) in infants with pulmonary disease. The incidence of pneumothorax according to the underlying pulmonary disease was highest in congenital pneumonia (15.8%). The length of hospitalization was longer in the pneumothorax group. Of the pneumothorax, 28 (38.9%) were in the chest tube group and 44 (61.1%) were in the no chest tube group. The proportion of infants treated with mechanical ventilation was higher in the chest tube group. The time from birth to diagnosis, hospitalization days and duration of improvement of pneumothorax in chest X-ray were longer in the chest tube group than in the no chest tube group.

Conclusion

The incidence of pneumothorax was quite common among the full-term infants who were transferred due to dyspnea, there was no significant difference between the two groups except for the longer hospitalization days for pneumothorax group. Considering the length of hospitalization and the need for chest tube insertion, the possibility of pneumothorax should be considered in fullterm infants with dyspnea at primary medical institution.

Keywords: Pneumothorax, Term birth, Neonate, Dyspnea, Chest tubes

References

1. Chernick V, Avery ME. Spontaneous alveolar rupture at birth. Pediatrics. 1963; 32:816–24.

2. Hassan M, Begum M, Haque SMZ, Jahan N, Mannan A, Rob AWS. Pneumothorax in neonate. North Int Med Coll J. 2014; 5:357–9.

3. Jung JS, Park SW, Kim CS, Lee SL, Kwon TC. Clinical feature of neonatal pneumothorax induced by respiratory distress syndrome and pneumonia. Korean J Pediatr. 2009; 52:310–4.

4. Park SW, Yun BH, Kim KA, Ko SY, Lee YK, Shin SM. A clinical study about symptomatic spontaneous pneumothorax. Korean J Perinatol. 2006; 17:304–9.

5. 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.

6. Silva IS, Flôr-de-Lima F, Rocha G, Alves I, Guimarães H. Pneumothorax in neonates: a level III neonatal intensive care unit experience. J Pediatr Neonat Individual Med. 2016; 5:e050220.

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

8. 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.

9. 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.

10. Al Matary A, Munshi HH, Abozaid S, Qaraqei M, Wani TA, Abu-Shaheen AK. Characteristics of neonatal pneumothorax in Saudi Arabia: three years'experience. Oman Med J. 2017; 32:135–9.

11. Lim HS, Kim H, Jin JY, Shin YL, Park JO, Kim CH, et al. Characteristics of pneumothorax in a neonatal intensive care unit. J Korean Soc Neonatol. 2011; 18:257–64.

12. Shaireen H, Rabi Y, Metcalfe A, Kamaluddeen M, Amin H, Akierman A, et al. Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study. BMC Pediatr. 2014; 14:208.

13. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007; 196:147.e1–8.

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

15. Lee SG, Im JS, Choe HH. Clinical evaluation of neonatal pneumothorax. Korean J Thorac Cardiovasc Surg. 1995; 28:1132–8.

16. Steele RW, Metz JR, Bass JW, DuBois JJ. Pneumothorax and pneumomediastinum in the newborn. Radiology. 1971; 98:629–32.

17. Agrawal V, David RJ, Harris VJ. Classification of acute respiratory disorders of all newborns in a tertiary care center. J Natl Med Assoc. 2003; 95:585–95.

18. Ferreira CH, Carmona F, Martinez FE. Prevalence, risk factors and outcomes associated with pulmonary hemorrhage in newborns. J Pediatr (Rio J). 2014; 90:316–22.

19. Choi BJ, Jung JW, Bae SC, Park MS, Yang JI. Clinical study of outcome and predisposing factors for spontaneous pneumothorax in the neonates. Korean J Perinatol. 2000; 11:438–44.

20. Madansky DL, Lawson EE, Chernick V, Taeusch HW Jr. Pneumothorax and other forms of pulmonary air leak in newborns. Am Rev Respir Dis. 1979; 120:729–37.

Fig. 1.

Flowchart of the infants. PTX, pneumothorax.

Table 1.

Clinical Characteristics of Groups

	Chest tube (n=28)	No chest tube (n=44)	PTX total (n=72)	Control (n=461)
Gender (male/female)∗	13/15∗	34/10∗	47/25	313/148
Gestational age (weeks)	38.8±1.1	39.2±1.1	39.1±1.1	38.9±1.2
Birth weight (g)	3,287.9±407.6	3,281.2±413.3	3,283.8±408.2	3,299.5±376.1
C-section delivery	18 (64.3)	26 (59.1)	44 (61.1)	251 (54.4)
Apgar score
1 minute	8.0±1.1	7.8±0.9	7.9±1.0	8.1±4.0
5 minutes	9.1±0.7	9.0±0.6	9.1±0.7	9.1±0.7
Birth asphyxia	4 (14.3)	10 (22.7)	14 (19.4)	72 (15.6)
Maternal age (years)	33.8±4.7	32.8±3.7	33.2±4.1	33.0±4.2
Maternal disease	4 (14.3)	9 (20.5)	13 (18.1)	91 (19.7)
GDM, DM	2 (7.1)	6 (13.6)	8 (11.1)	32 (6.9)
HTN, PIH, preeclampsia, eclampsia	2 (7.1)	1 (2.3)	3 (4.2)	6 (1.3)
Infection	0 (0)	2 (4.5)	2 (2.8)	26 (5.6)
PROM	1 (3.6)	0 (0)	1 (1.4)	25 (5.4)
Preterm labor	0 (0)	0 (0)	0 (0)	9 (2.0)
Others	0 (0)	0 (0)	0 (0)	5 (1.0)
Perinatal history	4 (14.3)	14 (31.8)	18 (25.0)	79 (17.1)
Meconium stained amniotic fluid	3 (10.7)	10 (22.7)	13 (18.1)	60 (13.0)
Oligohydramnios	1 (3.6)	2 (4.5)	3 (4.2)	1 (0.2)
Fetal distress	0 (0)	2 (4.5)	2 (2.8)	3 (0.7)
Nuchal cord	0 (0)	1 (2.3)	1 (1.4)	12 (2.6)
Cord prolapse	0 (0)	1 (2.3)	1 (1.4)	1 (0.2)
Polyhydramnios	0 (0)	0 (0)	0 (0)	4 (0.9)
Fetal tachycardia	0 (0)	0 (0)	0 (0)	1 (0.2)
Resuscitation at birth	2 (7.1)	4 (9.1)	6 (8.3)	19 (4.1)
PPV	2 (7.1)	2 (4.5)	4 (5.6)	10 (2.2)
Intubation	0 (0)	2 (4.5)	2 (2.8)	8 (1.7)
Chest compression	0 (0)	0 (0)	0 (0)	1 (0.2)
Time of diagnosis (hours)∗	12.2±6.9∗	8.2±7.8∗

Values are presented as mean±standard deviation or number (%). Abbreviations: PTX, pneumothorax; GDM, gestational diabetes mellitus; DM, diabetes mellitus; HTN, hypertension; PIH, pregnancy induced hypertension; PROM, prema ture rupture of membranes; PPV, positive pressure ventilation. ∗P<0.05 compared chest tube group to no chest tube group.

Table 2.

Result of Treatment

	Chest tube (n=28)	No chest tube (n=44)	PTX total (n=72)	Control (n=461)
Mechanical ventilation∗	22 (78.6)∗	9 (20.5)∗	31 (43.1)	163 (35.4)
Duration of treatment (hours)	67.0±54.5	38.0±33.0	58.5±50.5	47.8±38.2
Mortality	1 (3.6)	0 (0)	1 (1.4)	0 (0)
,† Duration of hospitalization (days)∗	10.1±6.7∗	6.0±3.0∗	† 7.6±5.1	† 6.1±3.3
Radiologic resolution of pneumothorax (days)∗	3.6±2.3∗	1.5±0.8∗

Values are presented as mean±standard deviation or number (%). Abbreviation: PTX, pneumothorax. ∗P<0.05 compared chest tube group to no chest tube group.

^† P<0.05 compared PTX group to control group.

Table 3.

Underlying Pulmonary Disease

	Chest tube (n=17)	No chest tube (n=18)	PTX total (n=35)	Control (n=461)
Congenital pneumonia∗	13 (76.5)	13 (72.2)	26 (74.3)∗	139 (30.2)∗
MAS	2 (11.8)	4 (22.2)	6 (17.1)	34 (7.4)
RDS	2 (11.8)	1 (5.6)	3 (8.6)	45 (9.8)
TTN∗	0 (0)	0 (0)	0 (0)∗	240 (52.1)∗
Pulmonary hemorrhage	0 (0)	0 (0)	0 (0)	3 (0.7)

Values are presented as number (%). Abbreviations: PTX, pneumothorax; MAS, meconium aspiration syndrome; RDS, respiratory distress syndrome; TTN, transient tachypnea of the newborn. ∗P<0.05 compared PTX group to control group.

Table 4.

Pneumothorax Incidence of Underlying Pulmonary Disease

	Congenital pneumonia (n=165)	MAS (n=40)	RDS (n=48)	TTN (n=240)	Pulmonary hemorrhage (n=3)
PTX	26 (15.8)	6 (15.0)	3 (6.3)	0 (0)	0 (0)
Control	139 (84.2)	34 (85.0)	45 (93.8)	240 (100)	3 (100)

Values are presented as number (%). Abbreviations: MAS, meconium aspiration syndrome; RDS, respiratory distress syndrome; TTN, transient tachypnea of newborn; PTX, pneumothorax.

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