PDF(1228 KB)
Etiology and prevention of neonatal pneumothorax
JI Ling, HUANG Na-Na, CHEN Dan
Chinese Journal of Contemporary Pediatrics ›› 2013, Vol. 15 ›› Issue (8) : 623-626.
PDF(1228 KB)
PDF(1228 KB)
Etiology and prevention of neonatal pneumothorax
OBJECTIVE: To investigate the risk factors and preventative measures for neonatal pneumothorax. METHODS: Retrospective analysis was performed on the clinical data of 2286 neonates who were hospitalized in the neonatal intensive care unit between October 2010 and November 2011, and a case-control study was conducted to analyze the risk factors and preventative measures for neonatal pneumothorax. RESULTS: The incidence of pneumothorax among the neonates was 1.57% (36/2286), and it was significantly higher in full-term infants than in preterm infants (23/1033 vs 13/1253, P=0.023). Logistic regression analysis indicated that cesarean section, neonatal respiratory distress syndrome (NRDS), wet lung, pneumonia and mechanical ventilation were the independent risk factors for neonatal pneumothorax (odds ratios=7.951, 6.090, 7.898, 6.272 and 4.389; P<0.05 for all). The higher the peak inspiratory pressure (PIP) during mechanical ventilation, the higher the incidence of neonatal pneumothorax (P<0.001). Pulmonary surfactant reduced the incidence of pneumothorax among neonates with NRDS (2.9% vs 10.1%; P=0.006). CONCLUSIONS: Neonatal pneumothorax occurs mostly in full-term infants. Cesarean section, NRDS, wet lung, pneumonia and mechanical ventilation are closely associated with neonatal pneumothorax. Strict management of indications for cesarean section, keeping PIP at a low level during mechanical ventilation, and use of pulmonary surfactant are helpful in preventing neonatal pneumothorax.
[1] Esme H, Dogru O, Eren S, Korkmaz M, Solak O. The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax[J]. Turk Pediatr, 2008, 50(3): 242-246.
[2] 邵肖梅, 叶鸿瑁, 邱小汕.实用新生儿学[M]. 第4版.北京:人民卫生出版社, 2011: 412-416.
[3] Apiliogullari B, Sunam GS, Ceran S, Koc H. Evaluation of neonatal pneumothorax[J]. J Int Med Res, 2011, 39(6): 2436-2440.
[4] Kim SK, Kim WH. Tension pneumothorax in a newborn after Cesareansection delivery[J]. Korean J Anesthesiol, 2010, 59(6): 420-424.
[5] Benterud T, Sandvik L, Lindemann R. Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate[J]. Acta Obstet Gynecol Scand, 2009, 88(3): 359-361.
[6] 周齐, 刘维靖, 王凤英, 张海珍.新生儿自发性气胸产科因素分析[J].中国实用妇科和产科杂志, 2007, 23(3): 216-217.
[7] Girard I, Sommer C, Dahan S, Mitanchez D, Morville P. Risk factors for developing pneumothorax in full-term neonates with respiratory distress[J]. Arch Pediatr, 2012, 19(4): 368-373.
[8] Zenciroglu A, Aydemir C, Bas AY, Demirel N. Evaluation of predisposing and prognostic factors in neonatal pneumothorax cases[J]. Tuberk Toraks, 2006, 54(2): 152-156.
[9] Seger N, Soll R. Animal derived surfactant extract for treatment of respiratory distresssyndrome[EB/OL]. (2009-04-15)[2012-10-11].http//www.ncbi.nlm.nih.gov/pubmed/19370695. pdf.
[10] Biniwale M, Kleinman M. Safety of surfactant administration before transport of premature infants[J]. Air Med J, 2010, 29(4): 170-177.
[11] Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome [EB/OL]. (2009-01-21)[2012-10-11]. http//www.ncbi.nlm.nih.gov/pubmed/19160177. pdf.
[12] Watkinson M, Tiron I. Events before the diagnosis of a pneumothorax in ventilated neonates[J]. Arch Dis Child Fetal Neonatal Ed, 2001, 85(3): 201-203.
[13] Klinger G, Ish-Hurwitz S, Osovsky M, Sirota L, Linder N. Risk factors for pneumothorax in very low birth weight infants[J]. Pediatr Crit Care Med, 2008, 9(4): 398-402.
[14] 周伟,张秀芳,梁洪,张洪.新生儿机械通气并发气胸的特点及防治[J].中国当代儿科杂志, 2001, 3(3): 285-290.
[15] Vlahakis NE, Hubmayr RD. Invited review: plasma membrane stress failure in alveolar epithelial cells[J]. J Appl Physiol, 2000, 89(6): 2490-2496.
[16] Verbrugge SJ, Bohm SH, Gommers D, Zimmerman LJ, Lachmann B. Surfactant impairment after mechanical-ventilation with large alveolar surface area changes and effects of positive end-expiratory pressure[J]. Br J Anaesth, 1998, 80(3): 360-364.
[17] 施丽萍,孙眉月,杜立中.新生儿呼吸窘迫综合征呼吸机治疗的肺保护性研究[J].中华儿科杂志, 2003, 41(2): 95-98.
[18] Wheeler K, Klingenberg C, McCallion N, Morley CJ, Davis PG. Volume-targetedversus pressure-limited ventilation in the neonate[J]. Cochrane Database Syst Rev, 2010, (11): CD003666.
