PNEUMOTHORAX IN NEWBORN AND COMPARISON OF DEMOGRAPHIC AND CLINICAL FEATURES ACCORDING TO DRAINAGE TREATMENT REQUIREMENT WITH CHEST TUBE

Abstract

Objective: Pneumothorax, which is an important cause of morbidity and mortality especially in premature infants, is the most common neonatal period in childhood. Our aim is to evaluate newborns diagnosed as pneumothorax in our unit.

Material and Methods: The records of newborn babies who were diagnosed as pneumothorax in the Neonatal Intensive Care Unit of Zekai Tahir Burak Women's Health Education and Research Hospital between January 1, 2015 and December 31, 2015 were analyzed retrospectively. Newborn infants who were diagnosed radiologically as pneumothorax were included in the study. Major congenital anomalies were excluded from the study.

Results: The incidence of pneumothorax was 0.37% in all live births and 2.6% in the neonatal intensive care unit. The mean gestation age of the babies was 34.2 ± 3.6 weeks and birth weight was 2322 ± 841 gr. Of the 67 newborns with pneumothorax, 49 were male (73.1%), and 59 (88.1%) were born by cesarean section. TTN (38.8%) and RDS (31.3%) were the most common underlying pulmonary diseases in infants who developed pneumothorax. For the treatment of pneumothorax, 50 (74.7%) babies were treated with chest tube and 17 (25.3%) had no chest tube. Gestational age and birth weight were significantly lower in the drainage group (p <0.05). The duration of MV and NDA was significantly longer in the drainage group, but the free oxygen requirement was longer, but there was no significant difference. There was no difference between the two groups in terms of preterm morbidity and mortality.

Conclusion: In neonatal period, pneumothorax is frequently encountered and usually within the first two days. The most common underlying lung disease in premature infants is RDS, while term infants is TTN. About ¾ of newborns developing pneumothorax should be treated by inserting a chest tube. In case of pneumothorax development in infants with gestational age <32 weeks, a chest tube should be inserted in almost all of them. In infants who need drainage, the duration of invasive and noninvasive respiratory support and the time of hospitalization are significantly longer.

Keywords

• Pneumothorax,incidence,drainage

YENİDOĞANDA PNÖMOTORAKS VE GÖĞÜS TÜPÜ İLE DRENAJ TEDAVİSİ GEREKSİNİMİNE GÖRE DEMOGRAFİK VE KLİNİK ÖZELLİKLERİN KARŞILAŞTIRILMASI

Abstract

Amaç: Özellikle prematüre bebeklerde önemli bir morbidite ve mortalite nedeni olan pnömotoraks, çocukluk çağında en sık yenidoğan döneminde görülür. Amacımız, ünitemizde pnömotoraks tanısı konulan yenidoğanların değerlendirilmesidir.

Gereç ve Yöntemler: Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi Yenidoğan Yoğun Bakım ünitesinde 1 Ocak 2015 ile 31 Aralık 2015 tarihleri arasında pnömotoraks tanısı alarak izlenen yenidoğan bebeklerin kayıtları geriye dönük olarak incelenmiştir. Radyolojik olarak pnömotoraks tanısı doğrulanan yenidoğan bebekler çalışmaya dahil edildi. Majör konjenital anomalisi olanlar ise çalışma dışı bırakıldı.

Bulgular: Pnömotoraks insidansı, tüm canlı doğumlar içerisinde %0.37, yenidoğan yoğun ba­kım ünitesinde takibi yapılanlar arasında ise %2.6 olarak saptandı. Bebeklerin ortalama gestasyon yaşı 34.2±3.6 hafta ve doğum ağırlığı 2322±841 gr idi. Pnömotoraks saptanan 67 yenidoğanın 49’u erkek (%73.1) idi ve 59’unun (%88.1) sezaryen ile doğduğu saptandı. Pnömotoraks gelişen bebeklerde alttan yatan en sık primer akciğer hastalıklarının TTN (%38.8) ve RDS (%31.3) olduğu belirlendi. Pnömotoraks tedavisi için göğüs tüpü ile 50 (%74.7) bebeğe drenaj tedavisi uygulanırken, 17 (%25.3) bebeğin göğüs tüpü gereksinimi olmadı. Drenaj gereken grupta gestasyon yaşı ve doğum ağırlığı anlamlı olarak düşük bulundu (p<0.05). Drenaj gereken grupta MV ve NİV süreleri anlamlı olarak uzun iken, serbest oksijen gereksinimi de daha uzun olmakla birlikte anlamlı fark saptanmadı. Preterm morbiditeleri ve mortalite açısından iki grup arasında fark saptanmadı.

Sonuç: Yenidoğan döneminde pnömotoraks ile sık olarak ve genellikle ilk iki gün içerisinde karşılaşılır. Prematüre bebeklerde en sık altta yatan akciğer hastalığı RDS iken, term bebeklerde TTN’ dir. Pömotoraks gelişen yenidoğanların yaklaşık ¾’üne göğüs tüpü takılarak drenaj tedavisi gerekir. Gestasyon yaşı <32 hafta olan bebeklerde pnömotoraks gelişmesi durumunda neredeyse tamamına göğüs tüpü takılması gerekmektedir. Drenaj gereken bebeklerde invaziv ve noninvaziv solunum destek süreleri ile hastanede kalış zamanı belirgin olarak uzamaktadır.

Keywords

• Pnömotoraks,insidans,drenaj

References

1. 1.Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician 2007;76:987–94.
2. 2. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, et al. Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 2002;110:143–51.
3. 3. Aly H, Massaro A, Acun C, Ozen M. Pneumothorax in the newborn: clinical presentation, risk factors and outcomes. J Matern Fetal Neonatal Med. 2014;27:402–6.
4. 4. Ogata ES, Gregory GA, Kitterman JA, Phibbs RH, Tooley WH. Pneumothorax in the respiratory distress syndrome: incidence and effect on vital signs, blood gases, and pH. Pediatrics 1976;58:177–83.
5. 5. Goldberg RN, Abdenour GE. Air leak syndrome. In: Spitzer AR, ed. Intensive care of the fetus and neonate. St. Louis, MO: Mosby- Yearbook; 1996:629–40.
6. 6. Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal Pneumothorax: A Descriptive Regional Danish Study. Neonatology. 2017;111:303–308.
7. 7. Watkinson M, Tiron I. Events before the diagnosis of a pneumothorax in ventilated neonates. Arch Dis Fetal Neonatal Ed 2001;85: F201–3.
8. 8. Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol. 2008;35:273–81.

9. 9. Trevisanuto D, Doglioni N, Ferrarese P, Vedovato S, Cosmi E, Zanardo V: Neonatal pneumothorax: comparison between neonatal transfers and inborn infants. J Perinat Med 2005;33:449–54.
10. 10. Katar S, Devecioğlu C, Kervancioğlu M, Ulkü R: Symptomatic spontaneous pneumothorax in term newborns. Pediatr Surg Int 2006;22:755–758.
11. 11. Esme H, Doğru O, Eren S, Korkmaz M, Solak O: The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax. Turk J Pediatr 2008; 50: 242–6.
12. 12. Benterud T, Sandvik L, Lindemann R: Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate. Acta Obstet Gynecol Scand 2009;88: 359–61.
13. 13. Apiliogullari B, Sunam GS, Ceran S, Koc H. Evaluation of neonatal pneumothorax. J Int Med Res 2011;39:2436–40.
14. 14. Çördük N, Ürey T, Küçüktaşçı K, Özdemir ÖMA, Herek Ö, Büke AS, et al. Yenidoğan pnömotorakslı olguların değerlendirilmesi. Pam Tıp Derg 2014;7:47–51.
15. 15. Tudehop DI, Smyth MH: Is ‘transient tachypnoea of the newborn’ always a benign disease? Aust Paediatr J 1979;15:160–5.
16. 16. Reynolds EO: Hyaline membrane disease. Am J Obs Gynecol 1970;106: 780–94.
17. 17. Kolås T, Saugstad OD, Daltveit AK, Nilsen ST, Øian P: Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol 2006;195:1538–43.
18. 18. Cizmeci MN, Kanburoglu MK, Akelma AZ, Andan H, Akin K, Tatli MM. An abrupt increment in the respiratory rate is a sign of neonatal pneumothorax. J Matern Fetal Neonatal Med 2015;28:583–7.
19. 19. Özbek AS, Kavuncuoğlu S, Ugan Atik S, Aldemir EY, Payaslı M, Sander S. 2004-2008 Yılları arasında yenidoğan yoğun bakım ünitesinde pnömotoraks tanısıyla izlenen olguların incelenmesi. JOPP Derg 2011;3:79–85.
20. 20. Bhatia R, Davis PG, Doyle LW, Wong C, Morley CJ: Identification of pneumothorax in very preterm infants. J Pediatr 2011;159:115–120.e1.
21. 21. Zenciroglu A, Aydemir C, Bas AY, Demirel N. Evaluation of predisposing and prognostic factors in neonatal pneumothorax cases. Tuberk Toraks 2006;54:152–6.
22. 22. Bhat Yellanthoor R, Ramdas V. Frequency and intensive care related risk factors of pneumothorax in ventilated neonates. Pulm Med 2014;2014:727323.
23. 23. Klinger G, Ish-Hurwitz S, Osovsky M, Sirota L, Linder N. Risk factors for pneumothorax in very low birth weight infants. Pediatr Crit Care Med. 2008;9:398–402.
24. 24. Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med 2008;358:700–8.
25. 25. Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, Laptook AR, et al.; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med 2010;362:1970–9.
26. 26. Geary C, Caskey M, Fonseca R, Malloy M. Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration: a historical cohort study. Pediatrics 2008;121:89–96.