Pneumothorax and nasal continuous positive airway pressure ventilation in premature neonates: a note of caution

The nasal continuous positive airway pressure (NCPAP) ElectroMedical Equipment (EME) system has recently gained wide use in premature infants. However, occasional impingement of the expiratory tubing exit by mattress, coverings, or walls of infant warmers is of concern because of risk for obstruction and pneumothorax. The purpose of this study was to verify whether the use of NCPAP, namely Aladdin-1 (EME, Brighton, England), increases the risk for pneumothorax. The study included premature infants with respiratory distress who necessitated one or more of the following modes: oxygen via head box, NCPAP, synchronized intermittent mandatory ventilation (SIMV), or high frequency oscillatory ventilation (HFOV). For every patient, we recorded the modes of respiratory support, duration of use, and the occurrence of pneumothorax during every mode (number of pneumothorax cases/100 days of support). Among 163 sick premature neonates, pneumothorax developed in 0.17, 1.77, 0.3, and 6 cases per 100 days of oxygen via head box, NCPAP, SIMV, and HFOV, respectively. Pneumothorax developed more often during NCPAP than with SIMV. Pneumothorax in premature infants might be increased with the use of the newly developed NCPAP system. In these circumstances, possible accidental obstruction of the exit of its expiratory tubing could be contributory to this complication.