Pneumothorax In Newborns
Pneumothorax in Newborns is an abnormal condition in which air gets collected in the space between the lung and pleural membrane that surrounds it when the lung ruptures or leaks air.
- Pneumothorax usually develops in infants who have prolonged respiratory distress due to disorders of the lung or because of meconium aspiration syndrome. Infants hooked on to a ventilator, and those who are undergoing continuous positive airway pressure (CPAP) treatment for respiratory distress, are also prone to pneumothorax.
- Difficulty in breathing, lowering of blood pressure, and lung collapse, are the symptoms of pneumothorax.
- The symptoms, and an x-ray of the chest showing the air collection, help diagnose the condition.
- When pneumothorax is detected, the infant is given supplemental oxygen, or kept in an oxygen-rich environment, and the accumulated air is drawn out from the pleural space with the help of a syringe and needle.
Infants who have stiff lungs, particularly those with respiratory distress syndrome, and those who have meconium aspiration syndrome, are at greater risk of developing pneumothorax. Occasionally, infants who are receiving respiratory support through CPAP or continuous positive airway pressure technique, which allows them to breathe normally while oxygen under slight pressure is delivered to them via nose prongs, develop pneumothorax. Infants on ventilator support also tend to develop this condition. When pneumothorax has developed due to continuous positive airway pressure or due to the pressure exerted by the ventilator, the infant’s lungs may collapse, resulting in increased difficulty in breathing. If pneumothorax develops from pressure due to the ventilator or CPAP, it can cause compression to the veins which are carrying blood to the infant’s heart, resulting in inadequate amount of blood in the heart. Consequently, less blood gets pumped out of the heart, leading to low blood pressure and associated complications.
Sometimes, the air leaking from the lungs enters the tissues in the center of the infant’s chest cavity, resulting in a condition called pneumomediastinum. This condition has no negative effect on breathing and usually resolves on its own.
Diagnosis and Treatment
The infants who have respiratory distress may be on ventilator support or undergoing continuous positive airway pressure treatment. Pneumothorax in infants is indicated when the existing breathing difficulties suddenly worsen or when the blood pressure drops. On physical examination, a reduction in the sounds usually produced when air enters and leaves the lung is noticed on the side of the chest where pneumothorax has occurred. The sounds are dampened by the accumulated air in the chest cavity. Positive transillumination is a technique that can be used to detect accumulation of air in the pleural cavity in premature babies. This procedure is conducted inside a dark room with a fiber-optic light used to illuminate the side of the chest where pneumothorax has occurred. An x-ray of the chest can show the air accumulation and confirm the diagnosis.
The treatment depends on the symptoms displayed by the infant with pneumothorax. If the condition is mild, and the infant is not showing any symptoms, no special treatment is necessary. An oxygen-rich environment may be created for a term baby, by keeping it in a tent which has oxygen pumped in for maintaining a higher oxygen level than normal air.
If the breathing difficulty is severe, with outward symptoms of labored breathing such as flaring of nostrils, or if the blood oxygen levels become low, the accumulated air has to be removed immediately. Low blood pressure, which develops due to impaired blood circulation as the veins entering the heart gets compressed, is another situation requiring immediate intervention. The accumulated air is drawn out with a syringe and needle. If this procedure needs to be repeated frequently, a plastic tube is inserted into the pleural cavity to suction out the air continuously. Babies on ventilator support, and those being treated with continuous positive airway pressure, need continuous removal of accumulated air through the suction tube. The arrangement may have to be left in place for several days till the pneumothorax is resolved.
Pneumomediastinum also may be detected in a chest x-ray, but it usually resolves without any treatment.
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Yasser Elnahas
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