Ngerncham Sopapan, Kittiratsatcha Pornpat, Pacharn Preeyacha
Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2005 Nov;88 Suppl 8:S135-41.
Pneumothorax is one of the air leak syndrome and is more common in the newborn period than in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumothorax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneumothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline to prevent this condition.
This is a retrospective case-control study. CASEs were infants with the diagnosis of pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and December 2004. Controls were those whose birth times followed in the immediate chronology to the cases.
control ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence interval were used to identify possible risk factors. Statistical significance was considered as p < 0.05.
There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight (19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0), low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal care (3.5; 1.04, 11.9).
All pregnant women should be encouraged to have good antenatal care. Mother who has complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression. For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resuscitation, when needed, should be done very carefully by following the American Heart Association and the American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.
气胸是空气泄漏综合征之一，在新生儿期比其他任何儿童时期都更常见。它可分为自发性气胸和由潜在肺部病变或辅助通气引起的继发性气胸。气胸会导致住院时间延长，在某些情况下甚至会导致死亡。迄今为止，很少有研究专注于确定气胸的危险因素。我们开展这项研究以确定气胸的危险因素，以便制定预防这种情况的指南。
这是一项回顾性病例对照研究。病例为2001年1月至2004年12月期间诊断为气胸（P25.1围生期起源的气胸）的婴儿。对照是那些出生时间紧跟病例之后的婴儿。
病例与对照的比例为1:2。采用单因素分析比较两组。比值比和95%置信区间用于确定可能的危险因素。统计学显著性以p<0.05为标准。
有44例病例和88例对照。危险因素以比值比和95%置信区间表示。与气胸风险较高相关的婴儿因素包括男性（2.6；1.2，5.6）、低出生体重（19.3；2.3，160.2）、真空吸引（20.9；1.1，403.4）、羊水胎粪污染（4.5；1.8，11.0）、1分钟阿氏评分低（78.3；4.5，1357.8）以及使用面罩正压通气（29.0；3.6，233.5）。与气胸风险较高相关的母亲因素是产前护理差（3.5；1.04，11.9）。
应鼓励所有孕妇进行良好的产前护理。在孕期和分娩期间有并发症的母亲应接受特殊护理以预防围产期抑郁。对于羊水胎粪污染的母亲，应适当考虑密切的胎儿监测以及分娩后气管内吸出胎粪以预防胎粪吸入。最后，在需要时，应按照美国心脏协会和美国儿科学会的指南非常谨慎地进行新生儿复苏，尤其是在进行面罩正压通气时。
