Ozer Esra Arun, Ergin Ali Yuksel, Sutcuoglu Sumer, Ozturk Can, Yurtseven Ali
Department of Neonatology, Tepecik Teaching and Research Hospital, Izmir, Turkey.
Department of Pediatrics, Tepecik Teaching and Research Hospital, Izmir, Turkey.
Iran J Pediatr. 2013 Oct;23(5):541-5.
Pneumothorax in newborns may result in a significant mortality and morbidity. To predict who will survive or die is of great importance in the clinical management. The aim of this study is to address whether assessment of pneumothorax size on chest X-ray may be a predictor of prognosis in newborns presenting with pneumothorax.
Of 5929 infants admitted to our neonatal intensive care unit (NICU) from January 2007 to April 2011, 60 (1.0%) newborns presenting with pneumothorax were included in the present study. Pneumothorax size was calculated by measuring the widest transverse diameter of pneumothorax area in the posteroanterior view and dividing it by the widest transverse diameter of thoracic cavity above the diaphragm. Clinical data were collected from the patients' records.
Overall mortality rate was 30% (18 patients). Pneumothorax size was significantly higher in nonsurvivors (31.1±2.8 vs 16.4±1.4, P < 0.001). The cut-off point of pneumothorax size for predicting survival was determined as 20%. The sensitivity was 72% whereas the specificity 83%. Preterm birth, low birth weight, resuscitation at birth, need for mechanical ventilation and chest tube insertion were of great significance in predicting mortality. However, of overall significant parameters, only pneumothorax size was the independent prognostic factor by regression analysis (P = 0.02).
We conclude that the calculation of pneumothorax size in the newborns is a predictor of prognosis with high sensitivity and specificity. Furthermore newborns with pneumothorax size greater than 20% are likely to have worse prognosis.
新生儿气胸可能导致显著的死亡率和发病率。在临床管理中，预测哪些新生儿能存活或死亡至关重要。本研究的目的是探讨胸部X线片上气胸大小的评估是否可作为新生儿气胸预后的预测指标。
在2007年1月至2011年4月入住我院新生儿重症监护病房（NICU）的5929例婴儿中，本研究纳入了60例（1.0%）出现气胸的新生儿。通过测量后前位胸片上气胸区域最宽的横径，并将其除以膈上胸腔最宽的横径来计算气胸大小。临床数据从患者记录中收集。
总体死亡率为30%（18例患者）。非存活者的气胸大小显著更高（31.1±2.8对16.4±1.4，P<0.001）。预测存活的气胸大小截断点确定为20%。敏感性为72%，特异性为83%。早产、低出生体重、出生时复苏、需要机械通气和插入胸管在预测死亡率方面具有重要意义。然而，在所有显著参数中，通过回归分析只有气胸大小是独立的预后因素（P = 0.02）。
我们得出结论，计算新生儿气胸大小是一种具有高敏感性和特异性的预后预测指标。此外，气胸大小大于20%的新生儿预后可能更差。
