Joshi Avadhesh, Kumar Manish, Rebekah Grace, Santhanam Sridhar
Christian Medical College and Hospital, Vellore, India.
J Matern Fetal Neonatal Med. 2022 Feb;35(3):520-524. doi: 10.1080/14767058.2020.1727880. Epub 2020 Feb 19.
Pneumothorax is a medical emergency and is associated with a significant increase in morbidity and mortality in newborns. It may lead to acute respiratory failure, systemic hypoperfusion, intraventricular hemorrhage (IVH), and death. There is a paucity of data from developing countries about the epidemiology of pneumothorax.
This descriptive study was planned to study the clinical and epidemiological profile of hospitalized neonates with pneumothorax.
In this retrospactive study neonates admitted to Neonatal Intensive Care Unit (NICU) from 1 January 2004 to 31 December 2016 were reviewed.Relevant statistical analyses were done.
There were 144,166 live births and 189 inborn cases of pneumothorax; hence, the incidence was 1.3 per 1000 live births. Males outnumbered females by a ratio of 2:1. 50.1% of affected neonates were preterm, mean gestational age being 35.2 ± 3.9 weeks. The mean birth weight was 2238 ± 794 g. Overall median age at diagnosis was 21 h (IQR: 4-48 h), longer in preterm neonates compared to term. Hyaline membrane disease (HMD) was the most common underlying pulmonary disorder. Pneumothorax was drained in 89.2% of tension and only 16.3% of nontension pneumothoraces. Approximately 20% of the neonates were treated with needle aspiration alone and about 24% were treated conservatively. Mortality rate among neonates with pneumothorax was 21.6%. Statistically significant risk factors for mortality were very low birth weight (VLBW) (OR: 2.47, 1.31-4.68), tension pneumothorax (OR: 2.79, 1.05-7.4), and pulmonary hypoplasia (OR: 7.5, 2.8-20.2). Multiple attempts of needle drainage were needed in 2.5% of the cases. The neonates, both term and preterm, requiring drainage had longer duration of hospital stay when compared to those without requirement of drainage.
We propose a trial of needle aspiration prior to ICD insertion and intubation which will prevent the complications related to intubation.
气胸是一种医疗急症，与新生儿发病率和死亡率的显著增加相关。它可能导致急性呼吸衰竭、全身低灌注、脑室内出血（IVH）和死亡。发展中国家关于气胸流行病学的数据匮乏。
本描述性研究旨在探讨住院气胸新生儿的临床和流行病学特征。
在这项回顾性研究中，对2004年1月1日至2016年12月31日入住新生儿重症监护病房（NICU）的新生儿进行了回顾。进行了相关的统计分析。
共有144,166例活产儿，其中189例为先天性气胸病例；因此，发病率为每1000例活产儿中有1.3例。男性与女性的比例为2:1。50.1%的患病新生儿为早产儿，平均胎龄为35.2±3.9周。平均出生体重为2238±794克。总体诊断时的中位年龄为21小时（四分位间距：4 - 48小时），早产儿比足月儿更长。透明膜病（HMD）是最常见的潜在肺部疾病。89.2%的张力性气胸进行了胸腔引流，而非张力性气胸仅为16.3%。约20%的新生儿仅接受了针吸治疗，约24%接受了保守治疗。气胸新生儿的死亡率为21.6%。死亡率的统计学显著危险因素为极低出生体重（VLBW）（比值比：2.47，1.31 - 4.68）、张力性气胸（比值比：2.79，1.05 - 7.4）和肺发育不全（比值比：7.5，2.8 - 20.2）。2.5%的病例需要多次进行针吸引流。与无需引流的新生儿相比，需要引流的足月儿和早产儿住院时间更长。
我们建议在插入胸腔闭式引流管（ICD）和插管前进行针吸试验，这将预防与插管相关的并发症。
