Pneumothorax in Neonates during Respiratory Support: Incidence, Timing, and Association with Mortality and Invasive Ventilation

Abstract

Aim: Pneumothorax , while a serious adverse event primarily associated with positive pressure respiratory support, is not well documented.  Our aim was to document the incidence and timing of pneumothorax, as well as its association with initial mode of ventilation (invasive or noninvasive) and mortality. Methods: We analyzed a database documenting the course of care and outcome of every neonate requiring noninvasive or invasive ventilation in one region of Poland (18 centers) over a 7-year period (5,551 cases). Results: The incidence in all infants was 5.1%. It was 7.2% in those initially treated with invasive ventilation, and 3.6% for those initially treated with noninvasive ventilation (p<0.001). The incidence of pneumothorax was also associated with an increased risk of mortality (11.4% vs 4.5% p<0.001). These both remained significant after controlling for baseline risk factors. Except for the intubated neonates >36 weeks EGA, the pneumothorax primarily occurred during the initial mode of ventilation and in the early days of respiratory support. Conclusıon: Significant pneumothorax tends to occur early in the course of respiratory support. It is more likely to be associated with invasive than noninvasive ventilation and is associated with a marked increased risk of mortality.   

Keywords

• Noninvasive ventilation
• pneumothorax
• mechanical ventilation
• neonatal outcome

References

1. Horbar JD, Soll RF, Edwards EH . The Vermont Oxford Network: a community of practice. Clin Perinaltol 2010;37:29
2. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, et al, Trends in mortality and morbidity for very low birth weight infants 1991 – 1999. Pediatrics 2002; 110:143–51.
3. Valls-i-Soler A, Pijoan J, Cuttini M, Cruz J, Pallas C, et al, on behalf of the EuroNeoStat Consortium. Very low birthweight and gestational age babies in Europe: EuroNeoStat. In: Zeitlin J, Ashna M (ed) European perinatal health report, 2008. EuroPeriStat Project, 2012 pp 183-94.
4. Finer NN, Carlo WA, on Behalf of the SUPPORT Subcommittee. Early CPAP versus Surfactant in Extremely Preterm Infants. N Engl J Med 2010;362:1970-79. Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, COIN Trial Investigators. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008; 358:700-8.
5. Yost CC, Soll RF. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 2000;CD001456.
6. Wilinska M, Bachman TE, Swietlinski J, Gajewska E, Meller J, et al. Impact of the shift to neonatal noninvasive ventilation in Poland: a population study. Pediatr Crit Care Med 2014;15:155-61