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Pneumothorax in a term newborn

Journal of Perinatology volume 44, pages 465–471 (2024)Cite this article

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Abstract

With the advent of surfactant and gentle ventilation, the incidence of neonatal pneumothorax has decreased over the last two decades. Pneumothorax associated with respiratory distress syndrome is more common in preterm infants, but term infants often present with isolated pneumothorax. The use of CPAP or non-invasive respiratory support in the delivery room for a term infant with respiratory distress increases transpulmonary pressures and increases the risk of pneumothorax. Prompt diagnosis with a high index of suspicion, quick evaluation by transillumination, chest X-ray or lung ultrasound is critical. Management includes observation, needle thoracocentesis and if necessary, chest tube placement. This manuscript reviews the incidence, pathogenesis, diagnosis and management of a term infant with isolated pneumothorax, summarizing the combination of established knowledge with new understanding, including data on diagnostic modes such as ultrasound, reviewing preventative measures, and therapeutic interventions such as needle thoracocentesis and a comparison of pigtail vs. straight chest tubes.

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Fig. 1: The role of transpulmonary pressure (Ptp) in creation of pulmonary air leak syndromes.
Fig. 2: Pathogenesis of pulmonary leak in term newborn infants.
Fig. 3: Radiological features of pneumothorax.
Fig. 4: Features for the use of POCUS for the rapid diagnosis of pneumothorax.
Fig. 5: Three bottle chest tube drainage system and its modern version of a “dry-suction” wall-suction apparatus.

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References

  1. Schulman J. Inborn NICU admission rates. The Problem of Practice Variation in Newborn Medicine: Critical Insights for Evaluating and Improving Quality. 1. Springer International Publishing; 2022. p. 145–52.

    Chapter  Google Scholar 

  2. Guglani L, Lakshminrusimha S, Ryan RM. Transient tachypnea of the newborn. Pediatr Rev/Am Acad Pediatr. 2008;29:e59–65.

    Article  Google Scholar 

  3. Alhassen Z, Vali P, Guglani L, Lakshminrusimha S, Ryan RM. Recent advances in pathophysiology and management of transient tachypnea of newborn. J Perinatol. 2021;41:6–16.

    Article  PubMed  Google Scholar 

  4. Kresmery P. Pneumothorax in the newborn. Neonatal Netw. 2000;19:62–53.

    Google Scholar 

  5. Greenough A, Rossor TE, Sundaresan A, Murthy V, Milner AD. Synchronized mechanical ventilation for respiratory support in newborn infants. Cochrane Database Syst Rev. 2016;9:Cd000456.

    PubMed  Google Scholar 

  6. Acun C, Nusairat L, Kadri A, Nusairat A, Yeaney N, Abu Shaweesh J, et al. Pneumothorax prevalence and mortality per gestational age in the newborn. Pediatr Pulmonol. 2021;56:2583–8.

    Article  PubMed  Google Scholar 

  7. Consortium on Safe L, Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S, et al. Respiratory morbidity in late preterm births. J Am Med Assoc. 2010;304:419–25.

    Article  Google Scholar 

  8. Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal pneumothorax: a descriptive regional Danish study. Neonatology. 2017;111:303–8.

    Article  PubMed  Google Scholar 

  9. Benterud T, Sandvik L, Lindemann R. Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate. Acta Obstet Gynecol Scand. 2009;88:359–61.

    Article  PubMed  Google Scholar 

  10. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013;369:2126–36.

    Article  CAS  PubMed  Google Scholar 

  11. McKnight CL, Burns B Pneumothorax. StatPearls: Treasure Island (FL), 2023.

  12. Karlberg P, Koch G. Respiratory studies in newborn infants. III. Development of mechanics of breathing during the first week of life. A longitudinal study. Acta Paediatr Suppl (Upps). 1962;135:121–9.

    CAS  PubMed  Google Scholar 

  13. Cook CD, Cherry RB, O’Brien D, Karlberg P, Smith CA. Studies of respiratory physiology in the newborn infant. I. Observations on normal premature and full-term infants. J Clin Investig. 1955;34:975–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications. Arch Intern Med. 1939;64:913–26.

    Article  Google Scholar 

  15. Tingay DG, Farrell O, Thomson J, Perkins EJ, Pereira-Fantini PM, Waldmann AD, et al. Imaging the respiratory transition at birth: unraveling the complexities of the first breaths of life. Am J Respiratory Crit Care Med. 2021;204:82–91.

    Article  Google Scholar 

  16. Lakshminrusimha S, Jobe AH. Baby’s first cries and establishment of gas exchange in the lung. Am J Respiratory Crit Care Med. 2021;204:11–13.

    Article  Google Scholar 

  17. Agostoni E, Taglietti A, Agostoni AF, Setnikar I. Mechanical aspects of the first breath. J Appl Physiol. 1958;13:344–8.

    Article  CAS  PubMed  Google Scholar 

  18. Ashmore PG. Spontaneous pneumothorax in the newborn. Can Med Assoc J. 1965;92:309–11.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Esme H, Doğru O, Eren S, Korkmaz M, Solak O. The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax. Turk J Pediatr. 2008;50:242–6.

    PubMed  Google Scholar 

  20. Kuhns LR, Bednarek FJ, Wyman ML, Roloff DW, Borer RC. Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination. Pediatrics. 1975;56:355–60.

    Article  CAS  PubMed  Google Scholar 

  21. Wyman ML, Kuhns LR. Accuracy of transillumination in the recognition of pneumothorax and pneumomediastinum in the neonate. Clin Pediatr. 1977;16:323–4.

    Article  CAS  Google Scholar 

  22. Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, et al. Lung ultrasound for diagnosing pneumothorax in the critically Ill neonate. J Pediatr. 2016;175:74–78 e71.

    Article  PubMed  Google Scholar 

  23. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, et al. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. 2020;24:65.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yousef N, Singh Y, De Luca D. “Playing it SAFE in the NICU” SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU. Eur J Pediatr. 2022;181:393–8.

    Article  PubMed  Google Scholar 

  25. Himebauch AS, Nishisaki A Basic lung ultrasound for the intensivist. In: Singh Y, Tissot C, Fraga MV, Conlon T (eds). Point-of-care ultrasound for the neonatal and pediatric intensivist. Springer Link: London UK, 2023.

  26. Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020;142:S524–S550.

    Article  PubMed  Google Scholar 

  27. Hishikawa K, Goishi K, Fujiwara T, Kaneshige M, Ito Y, Sago H. Pulmonary air leak associated with CPAP at term birth resuscitation. Arch Dis Child Fetal Neonatal Ed. 2015;100:F382–387.

    Article  PubMed  Google Scholar 

  28. Smithhart W, Wyckoff MH, Kapadia V, Jaleel M, Kakkilaya V, Brown LS, et al. Delivery room continuous positive airway pressure and pneumothorax. Pediatrics. 2019;144:e20190756.

    Article  PubMed  Google Scholar 

  29. Stocks EF, Jaleel M, Smithhart W, Burchfield PJ, Thomas A, Mangona KLM, et al. Decreasing delivery room CPAP-associated pneumothorax at >/=35-week gestational age. J Perinatol. 2022;42:761–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Shaireen H, Rabi Y, Metcalfe A, Kamaluddeen M, Amin H, Akierman A, et al. Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study. BMC Pediatr. 2014;14:208.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Clark SD, Saker F, Schneeberger MT, Park E, Sutton DW, Littner Y. Administration of 100% oxygen does not hasten resolution of symptomatic spontaneous pneumothorax in neonates. J Perinatol. 2014;34:528–31.

    Article  CAS  PubMed  Google Scholar 

  32. O’Brien J. Absorption atelectasis: incidence and clinical implications. AANA J. 2013;81:205–8.

    PubMed  Google Scholar 

  33. Lakshminrusimha S, Russell JA, Steinhorn RH, Ryan RM, Gugino SF, Morin FC 3rd, et al. Pulmonary arterial contractility in neonatal lambs increases with 100% oxygen resuscitation. Pediatr Res. 2006;59:137–41.

    Article  PubMed  Google Scholar 

  34. Lakshminrusimha S, Russell JA, Gugino SF, Ryan RM, Mathew B, Nielsen LC, et al. Adjacent bronchus attenuates pulmonary arterial contractility. Am J Physiol Lung Cell Mol Physiol. 2006;291:L473–478.

    Article  CAS  PubMed  Google Scholar 

  35. Klingenberg C, Wheeler KI, McCallion N, Morley CJ, Davis PG. Volume-targeted versus pressure-limited ventilation in neonates. Cochrane Database Syst Rev. 2017;10:Cd003666.

    PubMed  Google Scholar 

  36. Cools F, Offringa M, Askie LM. Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants. Cochrane Database Syst Rev. 2015:CD000104.

  37. Gonzalez F, Harris T, Black P, Richardson P. Decreased gas flow through pneumothoraces in neonates receiving high-frequency jet versus conventional ventilation. J Pediatr. 1987;110:464–6.

    Article  CAS  PubMed  Google Scholar 

  38. Ng EH, Shah V. Guidelines for surfactant replacement therapy in neonates. Paediatr Child Health. 2021;26:35–49.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Aurilia C, Ricci C, Tana M, Tirone C, Lio A, Gambacorta A, et al. Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: report of five cases. Ital J Pediatr. 2017;43:114.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Joshi A, Kumar M, Rebekah G, Santhanam S. Etiology, clinical profile and outcome of neonatal pneumothorax in tertiary care center in South India: 13 years experience. J Matern-fetal Neonatal Med. 2022;35:520–4.

    Article  CAS  PubMed  Google Scholar 

  41. Murphy MC, Heiring C, Doglioni N, Trevisanuto D, Blennow M, Bohlin K, et al. Effect of needle aspiration of pneumothorax on subsequent chest drain insertion in newborns: a randomized clinical trial. JAMA Pediatr. 2018;172:664–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wei YH, Lee CH, Cheng HN, Tsao LT, Hsiao CC. Pigtail catheters versus traditional chest tubes for pneumothoraces in premature infants treated in a neonatal intensive care unit. Pediatr Neonatol. 2014;55:376–80.

    Article  PubMed  Google Scholar 

  43. Panza R, Prontera G, Ives KN, Zivanovic S, Roehr CC, Quercia M, et al. Pigtail catheters versus traditional chest drains for pneumothorax treatment in two NICUs. Eur J Pediatr. 2020;179:73–79.

    Article  PubMed  Google Scholar 

  44. Reed RC, Waters BL, Siebert JR. Complications of percutaneous thoracostomy in neonates and infants. J Perinatol. 2016;36:296–9.

    Article  CAS  PubMed  Google Scholar 

  45. Zisis C, Tsirgogianni K, Lazaridis G, Lampaki S, Baka S, Mpoukovinas I, et al. Chest drainage systems in use. Ann Transl Med. 2015;3:43.

    PubMed  PubMed Central  Google Scholar 

  46. Chan YH, Yu EL, Kwok HC, Yeung YC, Yu WC. Clamping of chest drain before removal in spontaneous pneumothorax. J Cardiothorac Surg. 2021;16:24.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Basheer F, Aatif M, Saeed MHB, Jalil J. Clinical profile and outcome of neonatal pneumothorax in resource-limited neonatal intensive care unit. J Matern-fetal Neonatal Med. 2022;35:3373–8.

    Article  PubMed  Google Scholar 

  48. Jovandaric MZ, Milenkovic SJ, Dotlic J, Babovic IR, Jestrovic Z, Milosevic B, et al. Neonatal pneumothorax outcome in preterm and term newborns. Med (Kaunas). 2022;58:965.

    Google Scholar 

  49. Al Tawil K, Abu-Ekteish FM, Tamimi O, Al Hathal MM, Al Hathlol K, Abu Laimun B. Symptomatic spontaneous pneumothorax in term newborn infants. Pediatr Pulmonol. 2004;37:443–6.

    Article  PubMed  Google Scholar 

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Funding

The manuscript has not been previously published and is not under consideration by anyother publishing journal. All authors have agreed to the Journal of Perinatology submissionpolicies and have no conflicts of interest to declare. Funding for this review article was providedby NIH Grant RO1 grant. Funded by HD072929 (SL).

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Authors and Affiliations

  1. Department of Pediatrics, UC Davis Children’s Hospital, Sacramento, CA, USA

    Vidhi Jhaveri, Payam Vali, Evan Giusto & Satyan Lakshminrusimha

  2. Department of Pediatrics, Loma Linda University School of Clinical Medicine, Loma Linda, CA, USA

    Yogen Singh

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Contributions

VSJ, PV, SL contributed to teh conception and design and the first draft. YS contributed to the section on the use of ultrasound in the first draft as well as revisions. EG contributed to the section on setup in the first draft as well as revisions. VSJ, PV, and SL all revised the article. SL created the figures. All authors have contributed to the creation of this manuscript and approved of its contents.

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Correspondence to Vidhi Jhaveri.

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Jhaveri, V., Vali, P., Giusto, E. et al. Pneumothorax in a term newborn. J Perinatol 44, 465–471 (2024). https://doi.org/10.1038/s41372-024-01899-2

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