Original Article
Identification of Pneumothorax in Very Preterm Infants

https://doi.org/10.1016/j.jpeds.2010.12.016Get rights and content

Objective

To compare respiratory and other morbidities between very preterm infants with and without a pneumothorax and to determine whether infants at higher risk of pneumothorax can be identified early in their course.

Study design

Preterm infants at 23 to 28 weeks’ gestation with pneumothorax were compared with matched control subjects. Demographic and clinical data from birth through the first 72 hours were compared.

Results

Sixty-two (9.2%) of 675 infants had pneumothorax. There were no significant differences in the baseline maternal and infant characteristics. Mortality was significantly higher in the pneumothorax group (43%) versus control subjects (13%). There was no significant difference in continuous positive airway pressure or surfactant treatment or rates of intraventricular hemorrhage or bronchopulmonary dysplasia. Infants treated with early continuous positive airway pressure in the delivery room typically had pneumothorax on day 2 of life. Those who had pneumothorax had higher inspired fraction of oxygen before its diagnosis and over the first 12 hours of life than did control subjects.

Conclusions

Pneumothorax is associated with increased mortality and with severity of lung disease in the first day of life. It may be possible to identify babies at highest risk of pneumothorax on the basis of inspired fraction of oxygen in the first 12 hours of life.

Section snippets

Methods

This was a case-control study of preterm infants between 23 and 28 completed weeks’ gestation. Cases had development of a pneumothorax at The Royal Women’s Hospital, Melbourne, Australia, between January 1, 2002, and June 30, 2007. The Royal Women’s Hospital is a level III perinatal center with more than 5000 deliveries and 1400 admissions to the intensive care and special care nurseries per year. Infants less than 28 weeks completed gestational age who had a pneumothorax in the time period

Results

Over the 5½-year period, 675 babies were born between 23 and 28 completed weeks’ gestation; 62 (9.2%) infants had a pneumothorax. One (2%) infant was excluded because a matched control subject could not be identified. None had congenital pulmonary malformations. Data from 61 babies with a pneumothorax and 61 control subjects were analyzed.

There were no substantial differences in the baseline maternal and infant characteristics of the infants in the pneumothorax and control groups as shown in

Discussion

During the study period, 62 of 675 (9.2%) infants born at less than 29 weeks gestation had pneumothoraces, which is in keeping with rates of 7% to 12% reported in the United States8, 9 and the United Kingdom.10 The 43% mortality rate in the infants with pneumothoraces compared with 13% in the control subjects highlights the fact that pneumothorax is a serious disease worthy of further investigation and prevention.

The FiO2 data suggest that infants who have a pneumothorax have worse lung disease

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    Supported by the Australian National Health and Medical Research Council (Program Grant 384100). P.D. is supported in part by an Australian National Health and Medical Research Council Practitioner Fellowship. The authors declare no conflicts of interest.

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