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Madenci H, Uysal M. Risk factors associated with neonatal pneumothorax in the neonatal intensive care unit: 10 years of experience in a single-center. Pediatr Surg Int 2024; 41:46. [PMID: 39718595 DOI: 10.1007/s00383-024-05939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2024] [Indexed: 12/25/2024]
Abstract
BACKGROUND We aimed to evaluate the epidemiological characteristics, risk factors and prognostic factors affecting the clinical follow-up of patients who underwent tube thoracostomy due to pneumothorax in the neonatal intensive care unit of our hospital. METHODS In our study; 54 cases with neonatal pneumothorax underwent tube thoracostomy followed up in the neonatal intensive care unit between April 2014 and March 2023 were retrospectively analyzed. RESULTS The gestational age of the cases was between 28 and 38 weeks; 24 (44.4%) were premature and 30 (55.6%) were 36 weeks and above. Of the cases included in the study, 35 (64.8%) had primary lung disease and 19 (35.2%) had other anomalies accompanying pneumothorax. Mechanical ventilation was needed in 35 (64.8%) of the 54 cases included in the study. While all patients who did not require mechanical ventilation recovered, 10 of 35 patients (28.6%) who required mechanical ventilation died. The body weight of 10 of these 35 cases (28.6%) was 2500 g or less. CONCLUSION It was determined that accompanying primary lung disease, the need to connect to a ventilator, and bilateral pneumothorax significantly affected mortality and prognosis in premature babies, especially those weighing less than 2500 g, who were followed in the neonatal intensive care unit.
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Affiliation(s)
- H Madenci
- Department of Pediatric Surgery, University of Health Sciences Turkey, Konya City Health Application and Research Center, Konya, Türkiye
| | - M Uysal
- Department of Pediatric Surgery, Karamanoğlu Mehmetbey University, Karaman, Türkiye.
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Alhumaid S, Alnaim AA, Al Ghamdi MA, Alahmari AA, Alabdulqader M, Al HajjiMohammed SM, Alalwan QM, Al Dossary N, Alghazal HA, Al Hassan MH, Almaani KM, Alhassan FH, Almuhanna MS, Alshakhes AS, BuMozah AS, Al-Alawi AS, Almousa FM, Alalawi HS, Al Matared SM, Alanazi FA, Aldera AH, AlBesher MA, Almuhaisen RH, Busubaih JS, Alyasin AH, Al Majhad AA, Al Ithan IA, Alzuwaid AS, Albaqshi MA, Alhmeed N, Albaqshi YA, Al Alawi Z. International treatment outcomes of neonates on extracorporeal membrane oxygenation (ECMO) with persistent pulmonary hypertension of the newborn (PPHN): a systematic review. J Cardiothorac Surg 2024; 19:493. [PMID: 39182148 PMCID: PMC11344431 DOI: 10.1186/s13019-024-03011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND PPHN is a common cause of neonatal respiratory failure and is still a serious condition and associated with high mortality. OBJECTIVES To compare the demographic variables, clinical characteristics, and treatment outcomes in neonates with PHHN who underwent ECMO and survived compared to neonates with PHHN who underwent ECMO and died. METHODS We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of PPHN in neonates who underwent ECMO, published from January 1, 2010 to May 31, 2023, with English language restriction. RESULTS Of the 5689 papers that were identified, 134 articles were included in the systematic review. Studies involving 1814 neonates with PPHN who were placed on ECMO were analyzed (1218 survived and 594 died). Neonates in the PPHN group who died had lower proportion of normal spontaneous vaginal delivery (6.4% vs 1.8%; p value > 0.05) and lower Apgar scores at 1 min and 5 min [i.e., low Apgar score: 1.5% vs 0.5%, moderately abnormal Apgar score: 10.3% vs 1.2% and reassuring Apgar score: 4% vs 2.3%; p value = 0.039] compared to those who survived. Neonates who had PPHN and died had higher proportion of medical comorbidities such as omphalocele (0.7% vs 4.7%), systemic hypotension (1% vs 2.5%), infection with Herpes simplex virus (0.4% vs 2.2%) or Bordetella pertussis (0.7% vs 2%); p = 0.042. Neonates with PPHN in the death group were more likely to present due to congenital diaphragmatic hernia (25.5% vs 47.3%), neonatal respiratory distress syndrome (4.2% vs 13.5%), meconium aspiration syndrome (8% vs 12.1%), pneumonia (1.6% vs 8.4%), sepsis (1.5% vs 8.2%) and alveolar capillary dysplasia with misalignment of pulmonary veins (0.1% vs 4.4%); p = 0.019. Neonates with PPHN who died needed a longer median time of mechanical ventilation (15 days, IQR 10 to 27 vs. 10 days, IQR 7 to 28; p = 0.024) and ECMO use (9.2 days, IQR 3.9 to 13.5 vs. 6 days, IQR 3 to 12.5; p = 0.033), and a shorter median duration of hospital stay (23 days, IQR 12.5 to 46 vs. 58.5 days, IQR 28.2 to 60.7; p = 0.000) compared to the neonates with PPHN who survived. ECMO-related complications such as chylothorax (1% vs 2.7%), intracranial bleeding (1.2% vs 1.7%) and catheter-related infections (0% vs 0.3%) were more frequent in the group of neonates with PPHN who died (p = 0.031). CONCLUSION ECMO in the neonates with PPHN who failed supportive cardiorespiratory care and conventional therapies has been successfully utilized with a neonatal survival rate of 67.1%. Mortality in neonates with PPHN who underwent ECMO was highest in cases born via the caesarean delivery mode or neonates who had lower Apgar scores at birth. Fatality rate in neonates with PPHN who underwent ECMO was the highest in patients with higher rate of specific medical comorbidities (omphalocele, systemic hypotension and infection with Herpes simplex virus or Bordetella pertussis) or cases who had PPHN due to higher rate of specific etiologies (congenital diaphragmatic hernia, neonatal respiratory distress syndrome and meconium aspiration syndrome). Neonates with PPHN who died may need a longer time of mechanical ventilation and ECMO use and a shorter duration of hospital stay; and may experience higher frequency of ECMO-related complications (chylothorax, intracranial bleeding and catheter-related infections) in comparison with the neonates with PPHN who survived.
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Affiliation(s)
- Saad Alhumaid
- School of Pharmacy, University of Tasmania, Hobart, 7000, Australia.
| | - Abdulrahman A Alnaim
- Department of Pediatrics, College of Medicine, King Faisal University, 31982, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Abdulaziz A Alahmari
- Department of Pediatrics, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, 34212, Dammam, Saudi Arabia
| | - Muneera Alabdulqader
- Pediatric Nephrology Specialty, Pediatric Department, Medical College, King Faisal University, 31982, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Sarah Mahmoud Al HajjiMohammed
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Qasim M Alalwan
- Pediatric Radiology Department, King Fahad Hofuf Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36358, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Header A Alghazal
- Microbiology Laboratory, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed H Al Hassan
- Administration of Nursing, Al-Ahsa Health Cluster, Al-Ahsa Health Cluster, Ministry of Health, 36421, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Khadeeja Mirza Almaani
- Alyahya Primary Health Centre, Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 36341, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Fatimah Hejji Alhassan
- Alyahya Primary Health Centre, Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, 36341, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed S Almuhanna
- Department of Pharmacy, Maternity and Children Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Aqeel S Alshakhes
- Department of Psychiatry, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ahmed Salman BuMozah
- Administration of Dental Services, Al-Ahsa Health Cluster, Ministry of Health, 36421, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ahmed S Al-Alawi
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, 36421, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Fawzi M Almousa
- Pharmacy Department, Al Jabr Hospital for Eye, Ear, Nose and Throat, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Hassan S Alalawi
- Pharmacy Department, Imam Abdulrahman Alfaisal Hospital, C1 Riyadh Health Cluster, Ministry of Health, 14723, Riyadh, Saudi Arabia
| | - Saleh Mana Al Matared
- Department of Public Health, Kubash General Hospital, Ministry of Health, 66244, Najran, Saudi Arabia
| | | | - Ahmed H Aldera
- Pharmacy Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mustafa Ahmed AlBesher
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, 36361, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ramzy Hasan Almuhaisen
- Quality Assurance and Patient Safety Administration, Directorate of Health Affairs, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Jawad S Busubaih
- Gastroenterology Department, King Fahad Hofuf Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ali Hussain Alyasin
- Medical Store Department, Maternity and Children Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Abbas Ali Al Majhad
- Radiology Department, Prince Saud Bin Jalawi Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36424, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ibtihal Abbas Al Ithan
- Renal Dialysis Department, King Fahad Hofuf Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36441, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Ahmed Saeed Alzuwaid
- Pharmacy Department, Aljafr General Hospital, Al-Ahsa Health Cluster, Ministry of Health, 7110, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Mohammed Ali Albaqshi
- Pharmacy Department, Aljafr General Hospital, Al-Ahsa Health Cluster, Ministry of Health, 7110, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Naif Alhmeed
- Administration of Supply and Shared Services, C1 Riyadh Health Cluster, Ministry of Health, 14723, Riyadh, Saudi Arabia
| | - Yasmine Ahmed Albaqshi
- Respiratory Therapy Department, Maternity and Children Hospital, Al-Ahsa Health Cluster, Ministry of Health, 36422, Al-Hofuf, Al-Ahsa, Saudi Arabia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, 31982, Al-Hofuf, Al-Ahsa, Saudi Arabia
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Masahata K, Nagata K, Terui K, Kondo T, Ebanks AH, Harting MT, Buchmiller TL, Sato Y, Okuyama H, Usui N. Risk Factors for Preoperative Pneumothorax in Neonates With Isolated Left-Sided Congenital Diaphragmatic Hernia: An International Cohort Study. J Pediatr Surg 2024; 59:1451-1457. [PMID: 38388286 DOI: 10.1016/j.jpedsurg.2024.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND We aimed to investigate the clinical characteristics and outcomes of patients with isolated left-sided congenital diaphragmatic hernia (CDH) who developed preoperative pneumothorax and determine its risk factors. METHODS We performed an international cohort study of patients with CDH enrolled in the Congenital Diaphragmatic Hernia Study Group registry between January 2015 and December 2020. The main outcomes assessed included survival to hospital discharge and preoperative pneumothorax development. The cumulative incidence of pneumothorax was estimated by the Gray test. The Fine and Gray competing risk regression model was used to identify the risk factors for pneumothorax. RESULTS Data for 2858 neonates with isolated left-sided CDH were extracted; 224 (7.8%) developed preoperative pneumothorax. Among patients with a large diaphragmatic defect, those with pneumothorax had a significantly lower rate of survival to discharge than did those without. The competing risks model demonstrated that a patent ductus arteriosus with a right-to-left shunt flow after birth (hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.21-2.63; p = 0.003) and large defects (HR: 1.65; 95% CI: 1.13-2.42; p = 0.01) were associated with an increased risk of preoperative pneumothorax. Significant differences were observed in the cumulative incidence of pneumothorax depending on defect size and shunt direction (p < 0.001). CONCLUSIONS Pneumothorax is a significant preoperative complication associated with increased mortality in neonates with CDH, particularly in cases with large defects. Large diaphragmatic defects and persistent pulmonary hypertension were found to be risk factors for preoperative pneumothorax development. LEVEL OF EVIDENCE LEVEL Ⅲ Retrospective Comparative Study.
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Affiliation(s)
- Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan; Department of Pediatric Surgery, Aizenbashi Hospital, Osaka, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuya Kondo
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
| | - Ashley H Ebanks
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan.
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Baudat-Nguyen J, Schneider J, Roth-Kleiner M, Barrielle L, Diebold P, Duvoisin G, El Faleh I, Grupe S, Huber BM, Morel AS, Paccaud Y, Torregrossa A, Younes D, Tolsa JF, Truttmann AC. Incidence and Management of Neonatal Pneumothorax in a 10-Hospital Regional Perinatal Network in Switzerland: A Retrospective Observational Study. Am J Perinatol 2024; 41:e3305-e3312. [PMID: 38154466 PMCID: PMC11150061 DOI: 10.1055/s-0043-1777861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/17/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Pneumothorax (PTX) is a potentially life-threatening condition that affects neonates, with an incidence of 0.05 to 2%. Its management includes conservative treatment, chest tube (CT) drainage, and needle aspiration (NA). Aims were to evaluate the incidence of PTX in a 10-hospital perinatal network, its clinical characteristics and risk factors, and to compare the different treatment options. STUDY DESIGN All neonates diagnosed with PTX and hospitalized in the network were included in this retrospective observational trial over a period of 30 months. Primary outcome was the incidence of PTX. Secondary outcomes were the treatment modality, the length of stay (LOS), and the number of chest X-rays. RESULTS Among the 173 neonates included, the overall incidence of PTX was 0.56 per 100 births with a large range among the hospitals (0.12-1.24). Thirty-nine percent of pneumothoraces were treated conservatively, 41% by CT drainage, 13% by NA, and 7% by combined treatment. Failure rate was higher for NA (37%) than for CT drainage (9%). However, the number of X-rays was lower for patients treated by NA, with a median of 6 (interquartile range [IQR] 4-6.25), than by CT drainage, with a median of 9 (IQR 7-12). LOS was shorter for NA than for CT drainage, with a median of 2 (IQR 1-4.25) and 6 days (IQR 3-15), respectively. Complications, including apnea and urinary retention, occurred in 28% of patients managed with CT drainage, whereas none was observed with NA. CONCLUSION High variability of PTX incidence was observed among the hospitals within the network, but these values correspond to the literature. NA showed to reduce the number of X-rays, the LOS, and complications compared with CT drainage, but it carries a high failure rate. This study helped provide a new decisional management algorithm to harmonize and improve PTX treatment within our network. KEY POINTS · Neonatal PTX is a frequent pathology with a high incidence requiring urgent management.. · We report a large variability of PTX incidence between different hospitals of the same network.. · Needle aspiration carries higher failure rate, shorter hospital stay duration without complications reported..
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Affiliation(s)
- Julie Baudat-Nguyen
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Juliane Schneider
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Roth-Kleiner
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Laureline Barrielle
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Patrick Diebold
- Department of Pediatrics, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Gilles Duvoisin
- Department of Pediatrics, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Ikbel El Faleh
- Department of Pediatrics, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Silke Grupe
- Department of Pediatrics, Yverdon Hospital, Yverdon, Switzerland
| | - Benedikt M. Huber
- Department of Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | | | - Yan Paccaud
- Clinic of Pediatrics, Hospital Center of Valais Romand, Hospital of Valais, Sion, Switzerland
| | - Anais Torregrossa
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Pediatrics, Morges Hospital, Morges, Switzerland
| | - Dany Younes
- Department of Pediatrics, De la Broye Intercantonal Hospital, Payerne, Switzerland
| | - Jean-François Tolsa
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anita C. Truttmann
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Abou Mehrem A, Blagdon A, Hoffman J, Dossani S, Anderson C, Spence T, Gilad E. Telemedicine-guided thoracentesis of tension pneumothorax in a term newborn. J Telemed Telecare 2024; 30:194-197. [PMID: 34310235 PMCID: PMC10748441 DOI: 10.1177/1357633x211034316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/04/2021] [Indexed: 11/16/2022]
Abstract
We describe a case of a term female infant born in a rural community hospital and who developed a left-sided spontaneous tension pneumothorax shortly after birth. We used telemedicine to guide the family physician and healthcare team at the referring hospital to perform a life-saving thoracentesis using an intravenous cannula. The cannula was kept in place to drain the persistent pneumothorax during transportation to the pediatric intensive care unit at the tertiary hospital.
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Affiliation(s)
- Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Ashley Blagdon
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Salma Dossani
- Southern Alberta Neonatal Transport Services, Foothills Medical Centre, Calgary, AB, Canada
| | - Christine Anderson
- Southern Alberta Neonatal Transport Services, Foothills Medical Centre, Calgary, AB, Canada
| | - Tanya Spence
- Alberta Children’s Hospital, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Eli Gilad
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital, Calgary, AB, Canada
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Oh SH, Jin HS, Park CH. Risk factors and neonatal outcomes of pulmonary air leak syndrome in extremely preterm infants: A nationwide descriptive cohort study. Medicine (Baltimore) 2023; 102:e34759. [PMID: 37653823 PMCID: PMC10470716 DOI: 10.1097/md.0000000000034759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Most extremely preterm infants (EPIs), who were born before 28 weeks of gestation, with pulmonary air leak syndrome (ALS) are symptomatic, often severe, and require drainage. EPIs with severe air leak syndrome (sALS) that require tube drainage or needle aspiration are at high risk of morbidities and mortality. This study aimed to investigate perinatal characteristics, morbidities, and mortality in EPIs with sALS, and to estimate the risk of mortality according to gestational age (GA). A prospective cohort study conducted from 2013 to 2020 compiled the Korean Neonatal Network database to evaluate the incidence, perinatal characteristics, and outcomes of sALS in EPIs born before 28 weeks of gestation. Among 5666 EPIs, the incidence of sALS was 9.4% and inversely related to GA. From this cohort, we compared 532 EPIs with sALS to 1064 EPIs without sALS as controls, matching the subjects by GA and birth weight. Preterm premature rupture of membranes, oligohydramnios, resuscitation after birth, low Apgar scores, repeated surfactant administration, persistent pulmonary hypertension of the newborn, and pulmonary hemorrhage were associated with the development of pneumothorax. The sALS group required a higher fraction of inspired oxygen and more invasive respiratory support at both 28 days of life and 36 weeks of postmenstrual age. The sALS group had a higher incidence of bronchopulmonary dysplasia and major brain injury. The mortality rate was higher in the sALS group than in the control group (55.3% vs 32.5%, P < .001), and the ALS group had a 1.7 times risk of mortality than the control group. More attention should be paid to sALS in EPIs because the frequency of sALS increased as GA decreased, and the risk of mortality was more significant at lower GA.
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Affiliation(s)
- Seong Hee Oh
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
- Department of Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun-Seung Jin
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
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Mosalli R. Clinical Profile and Outcome of Neonatal Pneumothorax: Seven Years of Experience in a Tertiary Care Center. Cureus 2023; 15:e37625. [PMID: 37200634 PMCID: PMC10185488 DOI: 10.7759/cureus.37625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Neonatal pneumothorax (NP) in neonates is a medical emergency with a significant incidence of morbidity and mortality. There is a paucity of national and regional data about the epidemiological and clinical profiles of pneumothorax. AIM The study aim is to identify the demographics, predisposing factors, clinical profiles, and outcomes of NP in a tertiary neonatal care center in Saudi Arabia. METHODS A retrospective study of all newborns admitted at the neonatal intensive care unit at International Medical Centre, Jeddah, Saudi Arabia, over seven years period between January 2014 and December 2020 was reviewed. A total of 3,629 newborns admitted to the neonatal intensive care unit were included in the study. Data collected included baseline characteristics, predisposing factors, associated morbidities, management, and outcomes of NP. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). RESULTS Of a total of 3,692 included neonates, pneumothorax was detected in 32 neonates with an incidence of 1.02% (ranging from 0.69% to 2%), and 53.1% were males. The mean gestational age was 32 weeks. Our study found that most infants with pneumothorax were extremely low birth weight (ELBW) in 19 babies (59%). The most common predisposing factors were respiratory distress syndrome in 31 babies (96.9%) followed by the need for bag-mask ventilation in 26 babies (81.3%). Twelve newborns (37.5%) with pneumothorax died. Following an analysis of all risk variables, the one-minute Apgar score <5, associated intraventricular hemorrhage, and respiratory support need were shown to be significantly linked with death. CONCLUSION Pneumothorax is not an uncommon neonatal emergency event, especially for ELBW infants, infants requiring respiratory support, or infants with underlying lung disease. Our study describes the clinical profile and affirms the significant burden of NP.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, Umm Al-Qura University, Makkah, SAU
- Department of Pediatrics, International Medical Center, Jeddah, SAU
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Zhang X, Zhang N, Ren YY. Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax. World J Clin Cases 2022; 10:12066-12076. [PMID: 36483838 PMCID: PMC9724522 DOI: 10.12998/wjcc.v10.i33.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.
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Affiliation(s)
- Xu Zhang
- Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Ning Zhang
- Department of Clinical Laboratory, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Yue-Yi Ren
- Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
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Jovandaric MZ, Milenkovic SJ, Dotlic J, Babovic IR, Jestrovic Z, Milosevic B, Culjic M, Babic S. Neonatal Pneumothorax Outcome in Preterm and Term Newborns. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:965. [PMID: 35888683 PMCID: PMC9320446 DOI: 10.3390/medicina58070965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Pneumothorax implies the presence of air in the pleural space between the visceral and parietal pleura. The aim of this study was to investigate the incidence, clinical characteristics, risk factors, therapy and perinatal outcome in neonates with pneumothorax in a tertiary care center. Materials and Methods: A retrospective study based on a five-year data sample of neonates with pneumothorax was conducted in a Maternity Hospital with a tertiary NICU from 2015 to 2020. We included all neonates with pneumothorax born in our hospital and compared demographic characteristics, perinatal risk factors, anthropometric parameters, comorbidities, clinical course and method of chest drainage between term (≥37 GW) and preterm (<37 GW) neonates. Results: The study included 74 newborns with pneumothorax, of which 67.6% were male and 32.5% were female. The majority of women (59.5%) had no complications during pregnancy. Delivery was mainly performed via CS (68.9%). Delivery occurred on average in 34.62 ± 4.03 GW. Significantly more (p = 0.001) children with pneumothorax were born prematurely (n = 53; 71.6%) than at term (n = 21; 28.4%). Most of the neonates had to be treated with ATD (63.5%) and nCPAP (39.2%), but less often they were treated with surfactant (40.5%) and corticosteroids (35.1%). O2 therapy lasted an average of 8.89 ± 4.57 days. Significantly more (p = 0.001) neonates with pneumothorax had additional complications, pneumonia, sepsis, convulsions and intraventricular hemorrhage (68.9%). However, most children had a good outcome (83.8%) and were discharged from the clinic. Fatal outcomes occurred in six cases, while another six neonates had to be transferred to referral neonatal centers for further treatment and care. Conclusion: Significantly more children with pneumothorax were born prematurely than at term. With adequate therapy, even premature newborns can successfully recover from pneumothorax.
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Affiliation(s)
- Miljana Z. Jovandaric
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Svetlana J. Milenkovic
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Jelena Dotlic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana R. Babovic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Zorica Jestrovic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
| | - Branislav Milosevic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
| | - Miljan Culjic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
| | - Sandra Babic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
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Kim EA, Jung JH, Lee SY, Park SH, Kim JS. Neonatal Pneumothorax in Late Preterm and Full-Term Newborns with respiratory Distress: A Single-Center Experience. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: To evaluate the incidence rate, clinical characteristics, and perinatal outcomes of pneumothorax in late preterm and full-term newborns with respiratory distress and analyze the risk factors associated with pneumothorax.Methods: Infants born at ≥34 weeks’ gestation with respiratory distress and pneumothorax admitted between February 2014 and December 2020 were enrolled in this study. The pneumothorax group (n=36) was matched to the control group (n=144) in a 1:4 ratio, based on gestational age and birth weight. Risk factors were identified using logistic regression analysis with backward stepwise selection.Results: The incidence of pneumothorax during the study period was 1.36% (38/2,788). All patients were diagnosed with pneumothorax within 48 hours after birth, and increased oxygen demand was the most common symptom. The proportion of mortality and perinatal morbidity, such as intraventricular hemorrhage ≥grade 3, was significantly higher in the pneumothorax group than in the control group. The risk factors associated with pneumothorax were the need for positive pressure ventilation in the delivery room (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.26 to 9.12; P=0.015) and a higher fraction of inspired oxygen to achieve an oxygen saturation of ≥90% on admission (OR, 1.06; 95% CI, 1.03 to 1.09; P<0.001).Conclusion: Pneumothorax should be suspected in late preterm and full-term newborns with respiratory distress within the first 3 days of life. Based on these risk factors, early diagnosis can reduce perinatal mortality and morbidity.
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MELEKOĞLU N, SİNANOĞLU MS, BERK E. Evaluation of Pneumothorax in Neonatal Intensive Care Unit. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.991806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study. Pediatr Surg Int 2020; 36:669-677. [PMID: 32346849 DOI: 10.1007/s00383-020-04659-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE This study aimed to elucidate the clinical characteristics of neonates with congenital diaphragmatic hernia (CDH) associated with pneumothorax and evaluate the risk factors for the development of pneumothorax. METHODS A retrospective cohort study was conducted in the 15 institutions participating in the Japanese CDH Study Group. A total of 495 neonates with isolated CDH who were born between 2011 and 2018 were analyzed in this study. RESULTS Among the 495 neonates with isolated CDH, 52 (10.5%) developed pneumothorax. Eighteen (34.6%) patients developed pneumothorax before surgery, while 34 (65.4%) developed pneumothorax after surgery. The log-rank test showed that the cumulative survival rate was significantly lower in patients with pneumothorax than in those without pneumothorax. Univariate analysis revealed significant differences between patients with pneumothorax and those without pneumothorax with regard to the best oxygenation index within 24 h after birth, mean airway pressure (MAP) higher than 16 cmH2O, diaphragmatic defect size, and need for patch closure. Multiple logistic regression analysis indicated that only the MAP was associated with an increased risk of pneumothorax. CONCLUSIONS The cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients.
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Joshi A, Kumar M, Rebekah G, Santhanam S. Etiology, clinical profile and outcome of neonatal pneumothorax in tertiary care center in South India: 13 years experience. J Matern Fetal Neonatal Med 2020; 35:520-524. [PMID: 32075452 DOI: 10.1080/14767058.2020.1727880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Pneumothorax is a medical emergency and is associated with a significant increase in morbidity and mortality in newborns. It may lead to acute respiratory failure, systemic hypoperfusion, intraventricular hemorrhage (IVH), and death. There is a paucity of data from developing countries about the epidemiology of pneumothorax. Objective: This descriptive study was planned to study the clinical and epidemiological profile of hospitalized neonates with pneumothorax. Material and methods: In this retrospactive study neonates admitted to Neonatal Intensive Care Unit (NICU) from 1 January 2004 to 31 December 2016 were reviewed.Relevant statistical analyses were done. Results: There were 144,166 live births and 189 inborn cases of pneumothorax; hence, the incidence was 1.3 per 1000 live births. Males outnumbered females by a ratio of 2:1. 50.1% of affected neonates were preterm, mean gestational age being 35.2 ± 3.9 weeks. The mean birth weight was 2238 ± 794 g. Overall median age at diagnosis was 21 h (IQR: 4-48 h), longer in preterm neonates compared to term. Hyaline membrane disease (HMD) was the most common underlying pulmonary disorder. Pneumothorax was drained in 89.2% of tension and only 16.3% of nontension pneumothoraces. Approximately 20% of the neonates were treated with needle aspiration alone and about 24% were treated conservatively. Mortality rate among neonates with pneumothorax was 21.6%. Statistically significant risk factors for mortality were very low birth weight (VLBW) (OR: 2.47, 1.31-4.68), tension pneumothorax (OR: 2.79, 1.05-7.4), and pulmonary hypoplasia (OR: 7.5, 2.8-20.2). Multiple attempts of needle drainage were needed in 2.5% of the cases. The neonates, both term and preterm, requiring drainage had longer duration of hospital stay when compared to those without requirement of drainage. Conclusion: We propose a trial of needle aspiration prior to ICD insertion and intubation which will prevent the complications related to intubation.
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Affiliation(s)
| | - Manish Kumar
- Christian Medical College and Hospital, Vellore, India
| | - Grace Rebekah
- Christian Medical College and Hospital, Vellore, India
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14
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Gregory A, Ewer AK, Singh A. Is high-concentration oxygen therapy more effective than targeted oxygen therapy in neonatal non-tension pneumothorax? Arch Dis Child 2019; 104:405-406. [PMID: 30389677 DOI: 10.1136/archdischild-2018-315659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Anna Gregory
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Andrew K Ewer
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Anju Singh
- Neonatal Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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15
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Hadzic D, Skokic F, Husaric E, Alihodzic H, Softic D, Kovacevic D. Risk Factors and Outcome of Neonatal Pneumothorax in Tuzla Canton. Mater Sociomed 2019; 31:66-70. [PMID: 31213960 PMCID: PMC6511380 DOI: 10.5455/msm.2019.31.66-70] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
AIM The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton. METHODS Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality. RESULTS During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax. CONCLUSION All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement therapy and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.
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Affiliation(s)
- Devleta Hadzic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Fahrija Skokic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Edin Husaric
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Hajriz Alihodzic
- Emergency Department of Health Center Tuzla, Bosnia and Herzegovina
| | - Dzenana Softic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Dzenita Kovacevic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
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16
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Gill PJ, Campbell DM. A newborn infant with respiratory distress: More than meets the eye. J Paediatr Child Health 2018; 54:327-329. [PMID: 29106049 DOI: 10.1111/jpc.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 07/24/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Peter J Gill
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Douglas M Campbell
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, St Michael's Hospital, Toronto, Ontario, Canada
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Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal Pneumothorax: A Descriptive Regional Danish Study. Neonatology 2017; 111:303-308. [PMID: 28013308 DOI: 10.1159/000453029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/03/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Neonatal pneumothorax (PTX) can occur due to underlying pulmonary disease and/or ventilatory support. PTX can also develop at the onset of respiration. PTX can be life-threatening, and prompt diagnosis is essential to reduce mortality. OBJECTIVE To analyse aetiology, demographic aspects, age at diagnosis, required treatment (specifically drainage), and prognosis of all cases of neonatal PTX observed in the North Jutland Region of Denmark from 1 January 2006 to 31 December 2014. METHOD Retrospective, descriptive, population-based cohort study. RESULTS During the study period there were 48,968 live births and 71 cases of PTX, giving an incidence of PTX of 0.14% (95% Cl: 0.11-0.18). Of these, 21% were bilateral and 59% tension PTX. Fifty-two percent of neonates affected were born at term. Almost all neonates had underlying lung disease, most commonly transient tachypnea of the newborn (TTN) in 39% and respiratory distress syndrome (RDS) in 42%. Only 3% were considered to have developed PTX at the onset of respiration. In preterm neonates, the median age at diagnosis was 28.5 h (IQR: 18.3-48.6), whereas in infants born at term the median age was 6.1 h (IQR: 1.1-17.2) (p < 0.001). Thirteen percent of PTX infants died. Fifty-nine percent of the infants required drainage of the PTX, more frequently those with RDS than TTN. CONCLUSION Almost all infants with PTX had underlying lung disease, divided equally between RDS and TTN. The diagnosis of PTX was made earlier in infants with TTN than RDS. Neonates with RDS required drainage more often than those with TTN.
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Affiliation(s)
- Louise Vibede
- Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
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18
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A case of bilateral tension pneumothorax—life saving intervention going wrong! Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Gupta AO, Ramasethu J. An innovative nonanimal simulation trainer for chest tube insertion in neonates. Pediatrics 2014; 134:e798-805. [PMID: 25092944 DOI: 10.1542/peds.2014-0753] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Competence in the chest tube insertion procedure is vital for practitioners who take care of critically ill infants. The use of animals for training is discouraged, and there are no realistic simulation models available for the neonatal chest tube insertion procedure. The objective of this study was to assess the effectiveness of teaching the chest tube insertion procedure by using an easily constructed, nonanimal simulation model. METHODS An inexpensive infant chest tube insertion model was developed by using simple hardware. A prospective cohort study with pre-posttest intervention design was conducted with pediatric and combined internal medicine-pediatrics residents. Residents completed a questionnaire about their previous experience of chest tube insertion, knowledge, self-evaluation of knowledge, comfort, and skills; pre, post, and a month after an individualized education session and demonstration of the procedure on the model. Clinical skills were assessed by using a 32-point scoring system when residents performed the procedure on the model immediately after training and a month later. RESULTS All residents had significant improvement in knowledge and self-evaluation of knowledge, comfort, and skills scores after the education session and training on the model and this improvement was retained after 1 month (P < .001). Clinical skills scores decreased slightly 1 month after training (P = .08). Scores were not significantly different between the levels of trainees. CONCLUSIONS An educational intervention using an easily constructed and inexpensive chest tube insertion model is effective in improving knowledge, comfort, and skills in trainees. The model can be used repeatedly to maintain proficiency.
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Affiliation(s)
- Ashish O Gupta
- MedStar Georgetown University Hospital, Washington, District of Columbia
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Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study. BMC Pediatr 2014; 14:208. [PMID: 25149271 PMCID: PMC4144685 DOI: 10.1186/1471-2431-14-208] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Little evidence exists regarding the optimal concentration of oxygen to use in the treatment of term neonates with spontaneous pneumothorax (SP). The practice of using high oxygen concentrations to promote “nitrogen washout” still exists at many centers. The aim of this study was to identify the time to clinical resolution of SP in term neonates treated with high oxygen concentrations (HO: FiO2 ≥ 60%), moderate oxygen concentrations (MO: FiO2 < 60%) or room air (RA: FiO2 = 21%). Methods A population based cohort study that included all term neonates with radiologically confirmed spontaneous pneumothorax admitted to all neonatal intensive care units in Calgary, Alberta, Canada, within 72 hours of birth between 2006 and 2010. Newborns with congenital and chromosomal anomalies, meconium aspiration, respiratory distress syndrome, and transient tachypnea of newborn, pneumonia, tension pneumothorax requiring thoracocentesis or chest tube drainage or mechanical ventilation before the diagnosis of pneumothorax were excluded. The primary outcome was time to clinical resolution (hours) of SP. A Cox proportional hazards model was developed to assess differences in time to resolution of SP between treatment groups. Results Neonates were classified into three groups based on the treatment received: HO (n = 27), MO (n = 35) and RA (n = 30). There was no significant difference in time to resolution of SP between the three groups, median (range 25th-75th percentile) for HO = 12 hr (8–27), MO = 12 hr (5–24) and RA = 11 hr (4–24) (p = 0.50). A significant difference in time to resolution of SP was also not observed after adjusting for inhaled oxygen concentration [MO (a HR = 1.13, 95% CI 0.54-2.37); RA (a HR = 1.19, 95% CI 0.69-2.05)], gender (a HR = 0.87, 95% CI 0.53-1.43) and ACoRN respiratory score (a HR = 0.7, 95% CI 0.41-1.34). Conclusions Supplemental oxygen use or nitrogen washout was not associated with faster resolution of SP. Infants treated with room air remained stable and did not require supplemental oxygen at any point of their admission.
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Abstract
Neonatal mortality is a major health care concern worldwide. Neonatal resuscitation alone does not address most causes of neonatal mortality; caregivers need to be trained in both neonatal resuscitation and stabilization. Neonatal stabilization requires caregivers to evaluate whether babies are at-risk or unwell, to decide what interventions are required, and to act on those decisions. Several programs address neonatal stabilization in a variety of levels of care in both well-resourced and limited health care environments. This article suggests a shift in clinical, educational, and implementation science from a focus on resuscitation to one on the resuscitation-stabilization continuum.
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Affiliation(s)
- Steven A Ringer
- Department of Newborn Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02492, USA
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Abstract
The pulmonary circulation rapidly adapts at birth to establish lungs as the site of gas exchange. Abnormal transition at birth and/or parenchymal lung disease can result in neonatal hypoxemic respiratory failure. This article reviews the functional changes in pulmonary hemodynamics and structural changes in pulmonary vasculature secondary to (1) normal and abnormal transition at birth, and (2) diseases associated with neonatal hypoxemic respiratory failure. Various management strategies to correct respiratory failure are also discussed.
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Affiliation(s)
- Satyan Lakshminrusimha
- Division of Neonatology, Women and Children's Hospital of Buffalo, State University of New York at Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.
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de Lange C. Radiology in paediatric non-traumatic thoracic emergencies. Insights Imaging 2011; 2:585-598. [PMID: 22347978 PMCID: PMC3259402 DOI: 10.1007/s13244-011-0113-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 04/07/2011] [Accepted: 06/14/2011] [Indexed: 11/30/2022] Open
Abstract
Non-traumatic thoracic emergencies in children are very frequent, and they usually present with breathing difficulties. Associated symptoms may be feeding or swallowing problems or less specific general symptoms such as fever, sepsis or chest pain. The emergencies always require a rapid diagnosis to establish a medical or surgical intervention plan, and radiological imaging often plays a key role. Correct interpretation of the radiological findings is of great importance in diagnosing and monitoring the illness and in avoiding serious complications. Plain radiography with fluoroscopy still remains the most important and frequently used tool to gain information on acute pulmonary problems. Ultrasound is the first choice for the detection and treatment of simple and complicated pleural effusions. Cross-sectional techniques such as multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are mainly used to study pulmonary/mediastinal masses and congenital abnormalities of the great vessels and the lungs. This article will discuss the choice of imaging technique, the urgency of radiological management and the imaging characteristics of acquired and congenital causes of non-traumatic thoracic emergencies. They represent common conditions involving the respiratory tract, chest wall and the oesophagus, as well as the less frequent causes such as tumours and manifestations of congenital malformations.
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Affiliation(s)
- Charlotte de Lange
- Department of Diagnostic Imaging and Intervention, Pediatric section, Oslo University Hospital, Rikshospitalet, P.O. box 4950 Nydalen, 0424 Oslo, Norway
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