[Pulmonary air-leakage in newborn infants].

BACKGROUND

Pulmonary air-leakage (PAL), especially pneumothorax, is a potentially severe complication of pulmonary disease in newborn infants. It is often related to therapeutic procedures such as resuscitation and mechanical ventilation.

MATERIAL AND METHODS

This is a prospective study of infants with PAL who were born in the period 1989-2006 and were hospitalised in an intensive care unit.

RESULTS

PAL occurred in 54 of 39,101 (1.4 per 1000) live-born infants; 34/54 (63%) were boys and 34/54 (63%) were born at term. 38/54 (70%) PAL cases had asphyxia and different pulmonary diseases, 16/54 (30%) PAL-incidences occurred spontaneously and 23/54 (43%) were diagnosed < 1 hour after birth. PAL occurred during resuscitation for perinatal asphyxia or initiation of mechanical ventilation in 18/54 (33%) patients, during CPAP-treatment in 12/54 (22%), and during mechanical ventilation after the start-up phase in 8/54 (15%) patients. Of 271 infants treated with mechanical ventilation, 144 (53%) were preterm infants with RDS. 64/114 (born 1992-2006) of these received a porcine surfactant and 3/64 (5%) developed PAL. The remaining 50 ventilated RDS-patients born in the same time period had a milder disease; 3/50 (6%) of these developed PAL (p > 0.05).

INTERPRETATION

PAL often occurred spontaneously and shortly after birth in connection with resuscitation and stabilization for respirator treatment. The risk for PAL in mechanically ventilated infants was lower once the start-up process had been completed. In infants who had received porcine surfactant for RDS the incidence of PAL during mechanical ventilation was low.