Universiti Tunku Abdul Rahman, Faculty of Medicine and Health Sciences, Department of Population Medicine, Malaysia.
Tengku Ampuan Rahimah Hospital, Department of Paediatrics, Ministry of Health, Klang, Selangor, Malaysia.
Malays J Pathol. 2023 Dec;45(3):441-456.
Information on incidence and risk factors associated with different types of neonatal pneumothorax were lacking globally.
To determine incidences of pneumothorax developed spontaneously and during different modes of respiratory support, and risk factors associated with each type of pneumothorax.
Retrospective observational study of neonates in the Malaysian National Neonatal Registry.
44 Malaysian neonatal intensive care units (NICUs).
All neonates born in 2015-2020 and admitted to NICUs.
Pneumothorax developed in 3265 neonates: 37.5% occurred spontaneously, 62.5% during respiratory support. The incidence of all types of pneumothorax was 1.75 per 1000 livebirths, and of spontaneous pneumothorax was 0.58 per 1000 livebirths. Pneumothorax developed in 0.6% (450/70512) of neonates during continuous positive air way pressure therapy (nCPAPt), 1.8% (990/54994) of neonates during conventional mechanical ventilation (CMV), and 7.0% (599/8557) of neonates during high frequency ventilation (HFV). Term neonates had significantly higher pneumothorax rate than preterms (p<0.001). Multiple logistic regression analyses show that exposure to intermittent positive pressure ventilation and chest compression at birth were significant independent factors associated with increased risk of spontaneous pneumothorax and CMV, and persistent pulmonary hypertension was associated with increased risk of spontaneous pneumothorax and pneumothorax during CMV and HFV.
The most common type of pneumothorax was spontaneous in-onset. Neonates on HFV had the highest and those on nCPAPt the lowest rate of pneumothorax. Improving training of resuscitation techniques at birth and strategies of use of invasive modes of respiratory support may reduce incidences of all types of pneumothorax.
全球范围内缺乏与不同类型新生儿气胸相关的发病率和危险因素信息。
确定自发性和不同呼吸支持模式下发生气胸的发生率，以及与每种气胸类型相关的危险因素。
马来西亚国家新生儿登记处的新生儿回顾性观察研究。
44 家马来西亚新生儿重症监护病房（NICU）。
2015-2020 年出生并入住 NICU 的所有新生儿。
3265 名新生儿发生气胸：37.5%自发性，62.5%在呼吸支持时发生。所有类型气胸的发生率为每 1000 例活产 1.75 例，自发性气胸发生率为每 1000 例活产 0.58 例。在持续气道正压通气（nCPAPt）中，0.6%（450/70512）的新生儿、常规机械通气（CMV）中 1.8%（990/54994）的新生儿和高频通气（HFV）中 7.0%（599/8557）的新生儿发生气胸。足月儿气胸发生率显著高于早产儿（p<0.001）。多因素逻辑回归分析显示，间歇性正压通气和出生时胸外按压暴露是与自发性气胸和 CMV 风险增加相关的独立因素，持续性肺动脉高压与自发性气胸和 CMV 和 HFV 时气胸风险增加相关。
最常见的气胸类型是自发性起病。使用 HFV 的新生儿气胸发生率最高，使用 nCPAPt 的新生儿气胸发生率最低。改善出生时复苏技术的培训和侵入性呼吸支持模式的使用策略可能会降低所有类型气胸的发生率。
