新生儿气胸：一项来自三个新生儿重症监护病房的队列研究。
Pneumothorax in newborns: a cohort study from three NICUs.
作者信息
Farghaly Mohsen A A, Ali Mahmoud A M, Acun Ceyda, Nandakumar Vanishree, Eltaly Hatem, Mohamed Mohamed A, Aly Hany
机构信息
Neonatology Division, Cleveland Clinic Children's, Cleveland, OH, USA.
West Virginia University School of Medicine, Morgantown, WV, USA.
出版信息
J Perinatol. 2025 Sep 4. doi: 10.1038/s41372-025-02408-9.
OBJECTIVE
To assess pneumothorax prevalence in neonates across gestational age (GA) categories, identify associated variables, and examine the impact of bubble CPAP (b-CPAP) implementation.
STUDY DESIGN
A cohort of 58,706 infants born at three hospitals over six years was analyzed, grouped by GA: ≥35 weeks, 29-34 weeks, and ≤28 weeks. Pneumothorax cases were matched with controls, and prevalence before and after b-CPAP adoption was compared.
RESULTS
Pneumothorax occurred in 310 infants (0.53%): 0.39% in ≥35 weeks, 4.0% in 29-34 weeks, and 4.6% in ≤28 weeks GA. Most cases occurred within 24 hours of birth, especially in ≥35 weeks (76%). In the ≥35-week group, pneumothorax was associated with male sex, chorioamnionitis, and delivery room CPAP. In the 29-34-week group, it was linked to small for gestational age, maternal diabetes, and surfactant use. In ≤28-week infants, delivery room intubation was the primary risk factor. Pneumothorax prevalence in non-intubated infants was unchanged after b-CPAP implementation (0.35% vs. 0.41%; aOR = 0.85, 95% CI: 0.62-1.16; P = 0.35).
CONCLUSION
Delivery room interventions, not NICU b-CPAP use, were associated with neonatal pneumothorax.
目的
评估不同胎龄（GA）新生儿气胸的患病率，确定相关变量，并研究实施气泡式持续气道正压通气（b-CPAP）的影响。
研究设计
对6年内在3家医院出生的58706例婴儿进行队列分析，按GA分组：≥35周、29 - 34周和≤28周。将气胸病例与对照组进行匹配，并比较采用b-CPAP前后的患病率。
结果
310例婴儿发生气胸（0.53%）：≥35周组为0.39%，29 - 34周组为4.0%，≤28周GA组为4.6%。大多数病例发生在出生后24小时内，尤其是≥35周组（76%）。在≥35周组，气胸与男性、绒毛膜羊膜炎和产房持续气道正压通气有关。在29 - 34周组，与小于胎龄、母亲糖尿病和使用表面活性剂有关。在≤28周婴儿中，产房插管是主要危险因素。实施b-CPAP后，非插管婴儿的气胸患病率无变化（0.35%对0.41%；校正比值比 = 0.85，95%置信区间：0.62 - 1.16；P = 0.35）。
结论
与新生儿气胸相关的是产房干预措施，而非新生儿重症监护病房使用b-CPAP。
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