Yu V Y, Liew S W, Robertson N R
Arch Dis Child. 1975 Jun;50(6):449-53. doi: 10.1136/adc.50.6.449.
The clinical course of pneumothorax and its allied conditions was studied in 34 newborn infants who presented over a 2 1/2-year period. We found an overall incidence of 3/1000 live births. 11 term infants without obvious pulmonary pathology presented early (9 within minutes of birth); 6 of these had aspirated meconium or blood. The remaining 23 were preterm infants with hyaline membrane disease (HMD) and accounted for 68% of the infants in this series. In contrast, they presented late (mean 45 hours) and 16 were on continuous distending pressure (CDP) or intermittent positive pressure ventilation (IPPV) at the onset of pneumothorax. 15% of all infants with HMD who required CDP/IPPV developed pneumothorax; this increased incidence was most evident in infants who received CDP only. All except 2 of the 11 term infants in the first group were managed conservatively and all survived. Wehn pneumothorax occurred as a complication of HMD in preterm infants, 14 of the 16 infants required intrapleural drainage. Persistence or recurrence of pneumothorax occurred in 9 infants, 7 of whom were receiving CDP/IPPV at the time. Lung expansion was affected only after replacement with a patent chest drain through the same incision or insertion of a second drain on the same side of the chest. All 5 deaths occurred in the group of preterm infants with HMD. 3 resulted directly form respiratory failure due to severe HMD complicated by pneumothorax. We emphasize the increasing importance of pneumothorax as a complication of HMD in preterm infants, particularly in those receiving CDP. Successful management depends on prompt diagnosis and treatment of pneumothorax, which may occur as unexplained sudden deterioration at any time during the course of illness in this group of high risk infants.
对34例在2年半期间出现的新生儿气胸及其相关病症的临床病程进行了研究。我们发现活产儿的总体发病率为3/1000。11例无明显肺部病变的足月儿发病较早（9例在出生后数分钟内）；其中6例吸入了胎粪或血液。其余23例为患有透明膜病（HMD）的早产儿，占本系列婴儿的68%。相比之下，他们发病较晚（平均45小时），16例在气胸发作时正在接受持续扩张压力（CDP）或间歇正压通气（IPPV）。所有需要CDP/IPPV的HMD婴儿中有15%发生了气胸；这种发病率的增加在仅接受CDP的婴儿中最为明显。第一组11例足月儿中除2例以外均采用保守治疗，全部存活。当气胸作为早产儿HMD的并发症发生时，16例婴儿中有14例需要进行胸腔内引流。9例婴儿出现气胸持续或复发，其中7例当时正在接受CDP/IPPV。只有在通过同一切口更换通畅的胸腔引流管或在胸部同一侧插入第二根引流管后，肺扩张才受到影响。所有5例死亡均发生在患有HMD的早产儿组。3例直接死于严重HMD并发气胸导致的呼吸衰竭。我们强调气胸作为早产儿HMD并发症的重要性日益增加，尤其是在接受CDP的婴儿中。成功的治疗取决于气胸的及时诊断和治疗，在这组高危婴儿的病程中，气胸可能在任何时候以无法解释的突然恶化形式出现。
