Lung perforation by chest tubes in the neonate

Area of Science:

• Neonatal Medicine
• Pediatric Surgery
• Pulmonary Medicine

Background:

• Intercostal drainage tubes are commonly used to manage air leaks in neonates with pulmonary disease.
• Pulmonary complications, including lung parenchyma penetration by chest tubes, can occur during treatment.
• Hyaline membrane disease (respiratory distress syndrome) is a frequent condition in premature infants requiring respiratory support.

Purpose of the Study:

• To determine the incidence of chest tube penetration of lung parenchyma in neonatal autopsies.
• To identify risk factors associated with lung laceration due to intercostal drainage tube insertion in neonates.

Main Methods:

• Retrospective autopsy analysis of 272 neonates.
• Review of cases where intercostal drainage tubes were inserted for pulmonary disease.
• Detailed examination for evidence of lung parenchyma laceration by chest tubes.

Main Results:

• Chest tubes were inserted in 70 of 272 neonates.
• Lung parenchyma penetration by chest tubes occurred in 9 cases (3.3% of all autopsies, 12.8% of those with chest tubes).
• Penetration was most common in infants <36 weeks' gestation with hyaline membrane disease, with left-sided insertion, after 5 days of age, and with multiple tube placements.

Conclusions:

• Chest tube placement in neonates carries a risk of iatrogenic lung injury.
• Prematurity and specific clinical factors (hyaline membrane disease, left-sided insertion, delayed insertion, multiple tubes) increase the risk of lung laceration.
• Careful consideration of insertion technique and timing may help minimize lung injury in neonates requiring chest drainage.