Abstract OBJECTIVE: To assess the predisposing factors, frequency and mortality of pneumothorax (PTX) among the newborns hospitalized in a neonatal intensive care unit (NICU) in Isfahan, Iran. METHODS: The data of 43 cases of PTX among the 738 neonates hospitalized in the NICU were analyzed retrospectively according to gestational age, birth weight, Apgar score, type of delivery, age of mother, parity, perinatal asphyxia, resuscitation at birth, side of PTX, mechanical ventilation, surfactant therapy, and underlying lung disorders. RESULTS: Mean gestational age was 31 weeks and birth weight was 1 596 g in the PTX cases. The gestational age of 12 (28%) neonates was less than 28 weeks. Twenty-eight (65%) neonates were below 1 500 g. In total, PTX occurred in 43 (5.8%) neonates. Sixty-three episodes of PTX (97%) were unilateral and 2 (3%) were bilateral. Respiratory distress syndrome (RDS) (40/43, 93%) and mechanical ventilation (37/43, 86%) were common predisposing factors of PTX. Overall, 28 (65%) neonates with PTX died. Birth weight, gestational age and chest tube duration were significantly different between dead and surviving infants. The mortality rate was significantly higher in neonates who required surfactant therapy than that in those who did not require it. CONCLUSIONS: The incidence and mortality of PTX in this study were higher than some other reports and this might be attributed to lower birth weight and gestational age. RDS and mechanical ventilation were the most common predisposing factors for the development of neonatal PTX, and mortality increased with lower birth weight, lower gestational age and more severe underlying primary lung disease.[Chin J Contemp Pediatr, 2010, 12 (6):417-420]
Fakhri NAVAEI,Banafshe ALIABADI,Masoud MOGHTADERI et al. Predisposing factors, incidence and mortality of pneumothorax in a neonatal intensive care unit in Isfahan, Iran[J]. 中国当代儿科杂志, 2010, 12(06): 417-420.
Fakhri NAVAEI,Banafshe ALIABADI,Masoud MOGHTADERI et al. Predisposing factors, incidence and mortality of pneumothorax in a neonatal intensive care unit in Isfahan, Iran[J]. CJCP, 2010, 12(06): 417-420.
[1]Crowley P. Prophylactic corticosteroids for preterm birth[J]. Cochrane Database Syst Rev, 2006, (3): CD 000065.
[2]Morley CJ. Systemic review of prophylactic vs rescue surfactant[J]. Arch Dis Child Fetal Neonatal Ed, 1997, 77(1): 70-74.
[3]Halliday HL, Natural VS. Synthetic surfactants in neonatal respiratory distress syndrome[J]. Drugs, 1996, 51(2):226-237.
[4]Kottmeier PK. Birth trauma[M]//Welch KJ, Rondolph JG, Ravitch MM, O′Neill JA, Rowe MI (eds). Pediatric Surgery. Chicago: Year Book Medical Publishers, 1986: 230-237.
[5]Powers WF, Clemens JD. Prognostic implications of age at detection of air leak in very low birth weight infants requiring ventilator support[J]. J Pediatr, 1993, 123(4): 611-617.
[6]Watkinson M, Tiron I. Events before the diagnosis of a pneumothorax in ventilated neonates[J]. Arch Dis Child Fetal Neonatal, 2001, 85(3): 201-203.
[7]Norton LE, Dimaid VJ, Zumvalt PE. Spontaneous pneumothorax in the newborn: a report of two fatalities[J]. J Forensic Sci, 1978, 23(1): 508-510.
[8]Ilce Z, Gundogdu G, Kara C, Ilikkan B, Celayir S. Which patients are at risk? Evaluation of the morbidity and mortality in newborn pneumothorax[J]. Indian Pediatr, 2003, 40(4): 325-328.
[9]Esme H, Dogru O, Eren S, Korkmaz M, Solak O. the factors affecting persistent pneumothorax and mortality in neonatal pneumothorax[J]. Turkish J Pediatrics, 2008, 50(3): 242-246.
[10]Powers WF, Clemens JD. Prognostic implications of age at detection of air detection of air leak in very low birth weight infants requiring ventilatory support[J]. J Pediatr, 1993, 123(4): 611-617.
[11]Mehrabani D, Gowen CW Jr, Kopelman AE. Association of pneumothorax and hypotension with intraventricular haemorrhage[J]. Arch Dis Child, 1991, 66(1 Spec No): 48-51.
[12]Bahatia J, Mathew OP. Resolution of pneumothorax in neonates[J]. Crit Care Med, 1985, 13(5): 417-419.
[13]Baumer H. International randomized controlled trial of patient triggered ventilation in neonatal respiratory distress syndrome[J]. Arch Dis Child Fetal Neonatal, 2000, 82(1): 5-10.
[14]Shaw NJ, Cooke RWI, Gill AB, Shaw NJ, Saeed M. Randomised trial of routine versus selective paralysis during ventilation for neonatal respiratory distress syndrome[J]. Arch Dis Child, 1993, 69(5 Spec No):479-482.
[15]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.
[16]Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome[J]. Chochrane Database Syst Rev, 2009, (1):CD 000141.