Pulmonary hemorrhage secondary to chest tube placement for pneumothorax in neonates

We report two neonates in whom placement of a chest tube for pneumothorax was followed by hemorrhage, shock, and subsequent death. An autopsy of one of the patients led us to the conclusion that bleeding had occurred from lung perforation. The intercostal artery had been clearly severed and may have contributed to the hemorrhage. We discuss pathogenesis, diagnosis, and offer suggestions for proper placement of the tube.