Effectiveness and safety of pneumothorax management in newborns without chest-tube insertion

Introduction
Pneumothorax is a serious complication associated with increased morbidity and mortality in newborns. However, chest-tube insertion, which is recommended for treatment of this pathology, is an invasive procedure, which can also lead to adverse clinical consequences.

Aim of the study
The aim of this study was to identify clinical features of infants with pneumothorax treated without chest-tube insertion.

Material and methods
In this case series study we report the clinical characteristics and outcomes in 31 outborn infants with pneumothorax, who were successfully managed without chest-tube insertion.

Results
Pneumothorax occurred at the median age of 2 (range: 0–4) days. Ten (32%) infants had a tension pneumothorax, and in five (16%) cases bilateral pneumothorax was observed. Mean birth weight of the newborns was 2287.42 ±755.45 γ and gestational age – 34.29 ±3.2 weeks. The majority of infants were late preterm (77%). Surfactant therapy was used in 23% of all cases. All infants had an underlying primary lung disease. Twenty-three (74%) infants were on non-invasive respiratory support at the time of pneumothorax occurrence, and 18 (78%) of them were switched to mechanical ventilation (MV) as soon as the diagnosis was confirmed. CPAP was the most commonly used type of initial respiratory support. The majority of infants did not need high ventilatory settings at the moment of pneumothorax occurrence. Needle aspiration was performed in 11 (35%) cases: in all 10 infants with tension pneumothorax and in one case of non-tension pneumothorax. Twenty (65%) infants were managed expectantly. High-frequency oscillatory ventilation (HFOV) was used in 13 cases – 50% of infants who were on MV. In total, 26 newborns with pneumothorax were successfully cared for on MV without chest tube placement.

Conclusions
A selected group of haemodynamically stable mechanically ventilated neonates with pneumothorax could be successfully treated without chest-tube insertion.