Flail chest in a neonate resulting from nonaccidental trauma

The authors present a 21-day-old infant who sustained a flail chest as a result of nonaccidental trauma. Initial treatment included endotracheal intubation and mechanical ventilation for hypoxemic respiratory failure followed by the administration of continuous positive airway pressure by nasal cannula. Further evaluation resulted in the identification of nonaccidental as the mechanism of injury. The pathophysiology of flail chest, its etiology, and treatment options are reviewed. In the absence of a documented history of significant thoracic injury or the presence of metabolic bone disease, nonaccidental trauma is the most likely diagnosis in infants and children with a flail chest.