Pneumothorax in the newborn: clinical presentation, risk factors and outcomes

We aimed to compare clinical presentation and risk factors associated with the development of pneumothorax among newborns of different birth weight (BW) categories.

We collected clinical and respiratory data on all newborns diagnosed with pneumothorax over a 10-year period. Infants were classified into two groups with BW ≥ 2500 g and <2500 g.

From 13,811 infants, we identified 77 with pneumothorax (BW ≥ 2500 g in 33 and BW <2500 g in 44 infants). The prevalence of pneumothorax in the two BW categories was 0.27% and 2.5%, respectively. Infants with BW ≥ 2500 g were diagnosed with neumothorax at a median age of 5.5 h, and mostly (70%) did not require intubation. Infants with BW <2500 g were diagnosed with pneumothorax at a median age of 34 h, presenting with hypercarbia and increased requirement for supplemental oxygen. The majority of these infants (89%) received mechanical ventilation after pneumothorax. When compared to matched controls, there was a lower proportion of African-American infants in the pneumothorax group (48% versus 73%, p = 0.029) and a higher rate of bronchopulmonary dysplasia (30% versus 7%, p = 0.004).

Onset, presentation and management of pneumothorax varied according to BW. Preterm infants with pneumothorax are at increased risk for developing bronchopulmonary dysplasia.