Pneumothorax in newborns: a cohort study from three NICUs
Mohsen A A Farghaly1, Mahmoud A M Ali2, Ceyda Acun1
1Neonatology Division, Cleveland Clinic Children's, Cleveland, OH, USA.
Summary
Neonatal pneumothorax is more common in premature infants. Delivery room interventions, such as intubation and CPAP, are linked to pneumothorax, not later bubble continuous positive airway pressure (b-CPAP) use in the NICU.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Critical Care
Background:
- Pneumothorax is a significant respiratory complication in neonates.
- Gestational age (GA) is a known risk factor for neonatal respiratory issues.
- The role of interventions like bubble continuous positive airway pressure (b-CPAP) in pneumothorax development requires clarification.
Purpose of the Study:
- To determine pneumothorax prevalence across different neonatal gestational age categories.
- To identify variables associated with pneumothorax in neonates.
- To evaluate the impact of bubble CPAP (b-CPAP) implementation on pneumothorax rates.
Main Methods:
- A retrospective cohort study of 58,706 neonates across three hospitals over six years.
- Infants were categorized by gestational age: ≥35 weeks, 29-34 weeks, and ≤28 weeks.
- Pneumothorax cases were matched with controls; prevalence before and after b-CPAP adoption was compared.
Main Results:
- Overall pneumothorax prevalence was 0.53%, with higher rates in lower GA groups (4.0% in 29-34 weeks, 4.6% in ≤28 weeks).
- Risk factors varied by GA: delivery room interventions (CPAP, intubation) were key in preterm infants, while male sex and chorioamnionitis were noted in those ≥35 weeks.
- Pneumothorax prevalence in non-intubated infants remained unchanged post-b-CPAP implementation.
Conclusions:
- Neonatal pneumothorax is strongly associated with gestational age and delivery room interventions.
- The implementation of bubble CPAP (b-CPAP) in the NICU setting did not significantly alter pneumothorax rates in non-intubated infants.
- Focusing on optimizing delivery room management may be crucial for reducing neonatal pneumothorax.
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