Review of neonatal pneumothoraces in tertiary neonatal units in Wales

Background: Pneumothorax is the most common air-leak syndrome resulting in significant morbidity and mortality in neonates.

We aimed to evaluate common clinical characteristics, any identifiable predisposing factors in neonates developing pneumothorax.

Methods: We retrospectively reviewed the medical records of all the neonates with pneumothorax admitted in 3 NICUs in Wales from January 2012 to December 2014.

Results:

Full clinical data was available in 83 neonates. More common in males 66.2% and most of the neonates were inborn (70%). Thirty-two (38.5%) were <34 weeks’ Gestation, 12 borderline preterm (14.4%) and 39 term babies (47%). About 78% of eligible babies (42) received atleast one dose of antenatal steroids. Fifty neonates (60%) required resuscitation at 5 mins (42) or more (9). Forty-six babies were intubated within Delivery room and majority of them within 10minutes at first attempt. Thirty-two babies received Surfactant. Almost all babies (82) needed respiratory support in the form of either mechanical ventilation (41), CPAP/BiPAP (32) or High-flow Nasal cannula (9). All the pneumthoraces were confirmed with chest x-ray and/or transillumination except one needing emergency needle thoracocentesis in the delivery room. Respiratory distress was the main feature (38) followed by increasing respiratory support (28). Six pneumothoraces were identified following a routine chest x-ray for line/tube placement. Pneumothoraces were commonly seen on right (40) and 18 neonates had bilateral pneumothoraces. Twenty-six resolved with expectant management while 53 needed either thoracotomy (30) or pigtail catheter (23). Three were drained by needle thoracocentesis. There was no significant difference in the complications seen with pigtail catheters or thoracotomy chest drains.

Conclusion: Common risk factors identified were preterm, respiratory distress, respiratory support.Commonest age at presentation <24 hrs. Conservative management successful in simple pneumothorax (34%).No difference in the complications seen with pigtail catheters or thoracotomy - chest drains.