Neonatal pneumothorax - 10 years of experience from a single center.

INTRODUCTION: Pneumothorax is detected in approximately 1-2% of all term newborns and this rate can reach 15-20% in neonatal intensive care units; tube thoracostomy is the traditional treatment in symptomatic newborns. The management of neonatal pneumothorax, and etiologies, and risk factors related to mortality were evaluated in this study.
METHODS: A total of 6647 newborns who were treated in the neonatal intensive care unit during the last ten years were evaluated retrospectively. Newborns with pneumothorax were included in the study. Demographic characteristics, treatment modalities, and outcomes were evaluated.
RESULTS: Pneumothorax was diagnosed in 124 (1.9%) newborns. The mean gestational age was 33.3±5.1 weeks and the mean birth weight was 2163.7±899.4 grams; 101 (81 %) were preterm and 40 (32%) were with very low birth weight newborns. Seventy-four (58%) newborns were diagnosed as having respiratory distress syndrome, the diagnosis was transient tachypnea of the newborn in 43 (35 %), meconium aspiration syndrome in 3 (2.5%) and pneumonia in 4 (3%). One hundred nineteen newborns were treated with tube thoracostomy. Spontaneous resolution was observed in five newborns with close follow-up. A total of 139 (bilateral pneumothorax in 20 newborns) tube thoracostomies were performed at the bedside with no major complication. The overall mortality rate was found as 21 %. Gestational ages were 33 weeks or less in 25 of the 26 deaths.
DISCUSSION AND CONCLUSION: Very low birth weight and prematurity in neonatal pneumothorax are associated with mechanical ventilation necessity and mortality. Tube thoracostomy with small-bore chest drains is safe and effective in the management.