Evaluation of neonatal pneumothorax cases in terms of underlying lung pathologies
Öz
Aim: This study aimed to compare newborns who were diagnosed and treated for pneumothorax due to various respiratory problems with those who had respiratory issues but did not develop pneumothorax in the neonatal intensive care unit. The comparison focused on epidemiological characteristics, risk factors, clinical course, and prognostic factors.
Materials and Methods: This retrospective cross-sectional study included 32 patients from 246 admitted to the neonatal intensive care unit for various respiratory problems in the early neonatal period between January 2020 and March 2021. The cases were divided into two groups: patients diagnosed and treated for pneumothorax while being monitored for respiratory problems (pneumothorax group, n=14) and patients with respiratory issues who continued to be monitored without developing pneumothorax (control group, n=18). Patient data were collected retrospectively from medical records and hospital databases.
Results: When the demographic characteristics of the groups were compared, no statistically significant differences were found between the two groups (p>0.05). Comparing clinical and radiological findings, it was observed that the duration of both non-invasive and invasive mechanical ventilation, antibiotic treatment, total parenteral nutrition, and transition to total oral feeding were longer in the pneumothorax group (p<0.05). Upon examining the clinical and radiological findings of the pneumothorax group, it was found that the diagnosis of pneumothorax was made on average within 27.3 hours, air leakage predominantly occurred in the left hemithorax (64.3%), 78.6% of the newborns had no additional air leakage findings or complications related to thoracic tube insertion, and the average duration of closed underwater drainage was 4.1 days.
Conclusion: This study demonstrated that pneumothorax in the neonatal period frequently occurs in cesarean-delivered infants, is more common in males, and is mostly located on the left hemithorax. The monitoring and treatment processes of infants who developed pneumothorax were shown to differ from those of infants without pneumothorax. The findings emphasize that clinicians' awareness of these characteristics can influence the clinical course and prognosis.
Anahtar Kelimeler
Kaynakça
- Zarogoulidis P, Kioumis I, Pitsiou G, Porpodis K, Lampaki S, Papaiwannou A, et al. Pneumothorax: from definition to diagnosis and treatment. J Thorac Dis. 2014 Oct;6(Suppl 4):S372-6.
- Smith J, Schumacher R, Donn S, Sarkar S. Clinical Course of Symptomatic Spontaneous Pneumothorax in Term and Late Preterm Newborns: Report from a Large Cohort. Am J Perinatol. 2011 Feb 10;28(02):163–8.
- Noppen M, De Keukeleire T. Pneumothorax. Respiration. 2008;76(2):121–7.
- Lai Y, Chia Y, Wen C, Hsu H, Chang H, Huang W. Association between risk of neonatal pneumothorax and mode of anesthesia for cesarean delivery at term: a nationwide population-based retrospective cohort study. Int J Obstet Anesth. 2017 May;30:80–1.
- Zanardo V, Padovani E, Pittini C, Doglioni N, Ferrante A, Trevisanuto D. The Influence of Timing of Elective Cesarean Section on Risk of Neonatal Pneumothorax. J Pediatr. 2007 Mar;150(3):252–5.
- 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 Mar 31;88(3):359–61.
- Andersson J, Magnuson A, Ohlin A. Neonatal pneumothorax: symptoms, signs and timing of onset in the post-surfactant era. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):5438–42.
- Kirby C, Trotter C. Pneumothorax in the Neonate: Assessment and Diagnosis. Neonatal Network. 2005 Sep;24(5):49–55.
- ALTER SJ. Spontaneous pneumothorax in infants: A10-year review. Pediatr Emerg Care. 1997 Dec;13(6):401–3.
- Aly H, Massaro A, Acun C, Ozen M. Pneumothorax in the newborn: clinical presentation, risk factors and outcomes. The Journal of Maternal-Fetal & Neonatal Medicine. 2014 Mar 24;27(4):402–6.
- Papoff P, Moretti C. Pulmonary Air Leakage in Newborns. In: Neonatology. Cham: Springer International Publishing; 2016. p. 1–13.
- Litmanovitz I, Carlo WA. Expectant Management of Pneumothorax in Ventilated Neonates. Pediatrics. 2008 Nov 1;122(5):e975–9.
- Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal Pneumothorax: A Descriptive Regional Danish Study. Neonatology. 2017;111(4):303–8.
- Wiswell TE, Henley MA. Intratracheal suctioning, systemic infection, and the meconium aspiration syndrome. Pediatrics. 1992 Feb;89(2):203–6.
- Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics. 1990 May;85(5):715–21.
- Prediger B, Mathes T, Polus S, Glatt A, Bühn S, Schiermeier S, et al. A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes. BMC Pregnancy Childbirth. 2020 Dec 8;20(1):395.
- Ali R, Ahmed S, Qadir M, Maheshwari P, Khan R. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series. Oman Med J. 2013 Jan 16;28(1):67–9.
- 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(3):242–6.
- Joshi A, Kumar M, Rebekah G, Santhanam S. Etiology, clinical profile and outcome of neonatal pneumothorax in tertiary care center in South India: 13 years experience. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Feb 1;35(3):520–4.
- Al Matary A, Munshi HH, Abozaid S, Qaraqei M, Wani TA, Abu-Shaheen AK. Characteristics of Neonatal Pneumothorax in Saudi Arabia: Three Years’ Experience. Oman Med J. 2017 Mar 15;32(2):135–9.
- Abdellatif MAK, Abdellatif DAK. Pneumothorax in the Neonatal Intensive Care Unit in Cairo University Hospital. J Egypt Soc Parasitol. 2012 Aug;42(2):495–506.
- Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: Trends, predictors and outcomes. J Neonatal Perinatal Med. 2014;7(1):29–38.
- Stoll BJ, Kliegman RM. Extrapulmonary extravasation of air. In: Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders; 2004. p. 586–7.
- Merenstein GB, Dougherty K, Lewis A. Early detection of pneumothorax by oscilloscope monitor in the newborn infant. J Pediatr. 1972 Jan;80(1):98–101.
- Katar S, Devecioğlu C, Kervancıoğlu M, Ülkü R. Symptomatic spontaneous pneumothorax in term newborns. Pediatr Surg Int. 2006 Sep 3;22(9):755–8.
- Ngerncham S, Kittiratsatcha P, Pacharn P. Risk factors of pneumothorax during the first 24 hours of life. J Med Assoc Thai. 2005 Nov;88 Suppl 8:S135-41.
- Liu J, Chi JH, Ren XL, Li J, Chen YJ, Lu ZL, et al. Lung ultrasonography to diagnose pneumothorax of the newborn. Am J Emerg Med. 2017 Sep;35(9):1298–302.
- Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, et al. Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate. J Pediatr. 2016 Aug;175:74-78.e1.
- Fei Q, Lin Y, Yuan TM. Lung Ultrasound, a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis. Ultrasound Med Biol. 2021 Mar;47(3):359–69.
- Smith J, Schumacher R, Donn S, Sarkar S. Clinical Course of Symptomatic Spontaneous Pneumothorax in Term and Late Preterm Newborns: Report from a Large Cohort. Am J Perinatol. 2011 Feb 10;28(02):163–8.
- Melekoğlu N, Sinanoğlu MS, Berk E. Evaluation of pneumothorax in the neonatal intensive care unit. Mustafa Kemal Üniversitesi Tıp Dergisi. 2022 Aug 1;13(46):168–73.
- Okumuş M, Zubarioğlu AU. Neonatal Pneumothorax - 10 Years of Experience From a Single Center. The Journal of Pediatric Research. 2020 May 14;7(2):163–7.
- Ilçe Z, Gündogdu G, Kara C, Ilikkan B, Celayir S. Which patients are at risk? Evaluation of the morbility and mortality in newborn pneumothorax. Indian Pediatr. 2003 Apr;40(4):325–8.
- Kitsommart R, Martins B, Bottino MN, Sant’Anna GM. Expectant Management of Pneumothorax in Preterm Infants Receiving Assisted Ventilation: Report of 4 Cases and Review of the Literature. Respir Care. 2012 May;57(5):789–93.
- Pocivalnik M, Meheden S, Griesmaier E, Trawöger R, Kiechl-Kohlendorfer U, Pichler G, et al. Pneumothorax unter Beatmung – ein Vergleich möglicher Therapieoptionen bei Reif- und Frühgeborenen. Klin Padiatr. 2013 Oct 24;225(07):389–93.
- Murphy MC, Heiring C, Doglioni N, Trevisanuto D, Blennow M, Bohlin K, et al. Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns: A Randomized Clinical Trial. JAMA Pediatr. 2018 Jul 1;172(7):664–9.
Pnömotorakslı yenidoğan olguların altta yatan akciğer patolojileri açısından değerlendirilmesi
Öz
Amaç: Bu çalışmada çeşitli solunumsal sorunlar nedeniyle yenidoğan yoğun bakım ünitesinde izlenirken pnömotoraks gelişen ve müdahale edilen bebeklerle, pnömotoraks gelişmeyen solunumsal sorunları olan bebeklerin epidemiyolojik özellikler, risk faktörleri, klinik seyir ve prognostik faktörler yönünden karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu retrospektif, kesitsel çalışmaya Ocak 2020-Mart 2021 tarihleri arasında çeşitli solunumsal sorunlar nedeniyle erken neonatal dönemde yenidoğan yoğun bakım ünitesine yatışı yapılan 246 hastadan 32’si dahil edildi. Olgular çeşitli solunumsal sorunları nedeniyle izlenirken pnömotoraks tanısı alan ve müdahale edilen hastalar (pnömotoraks grubu) (n=14) ve pnömotoraks gelişmeden solunum sorunları nedeniyle takibine devam edilen hastalar (kontrol grubu) (n=18) olmak üzere iki gruba ayrıldı. Hasta bilgileri geriye dönük hasta dosyalarından ve hastane veri tabanından taranarak kaydedildi.
Bulgular: Gruplar demografik özellikleri bakımından karşılaştırıldığında iki grup arasında istatistiksel anlamlı farklılık saptanmadı (p>0,05). Klinik ve radyolojik bulgular kıyaslandığında gerek non-invaziv, gerekse de invaziv mekanik ventilasyon tedavi süresinin, antibiyotik tedavi süresinin, total parenteral beslenme süresinin ve total oral beslenmeye geçiş süresinin pnömotoraks grubunda daha uzun olduğu görüldü (p<0,05). Pnömotoraks grubunun klinik ve radyolojik bulguları incelendiğinde pnömotoraks tanısının ortalama 27,3 saat içerisinde konulduğu, hava kaçağının çoğunlukla sol hemitoraksta gerçekleştiği (%64,3), yenidoğanların %78,6’sında eşlik eden ek hava kaçağı bulgusunun veya toraks tüpüne bağlı komplikasyonun olmadığı, kapalı su altı drenaj süresinin ortalama 4,1 gün olduğu görüldü.
Sonuç: Bu çalışmada neonatal dönemde pnömotoraksın sıklıkla sezaryenle doğan bebeklerde, en sık erkeklerde ve sol hemitoraksta olduğu gösterilirken, pnömotoraks gelişen bebeklerin izlem ve tedavi süreçlerinin pnömotoraks gelişmeyen bebeklere göre farklılıkları ortaya konmuş ve klinisyenlerin bu özellikler açısından farkındalıklarının seyir ve prognozu etkileyebileceğine dikkat çekilmek istenmiştir.
Anahtar Kelimeler
Kaynakça
- Zarogoulidis P, Kioumis I, Pitsiou G, Porpodis K, Lampaki S, Papaiwannou A, et al. Pneumothorax: from definition to diagnosis and treatment. J Thorac Dis. 2014 Oct;6(Suppl 4):S372-6.
- Smith J, Schumacher R, Donn S, Sarkar S. Clinical Course of Symptomatic Spontaneous Pneumothorax in Term and Late Preterm Newborns: Report from a Large Cohort. Am J Perinatol. 2011 Feb 10;28(02):163–8.
- Noppen M, De Keukeleire T. Pneumothorax. Respiration. 2008;76(2):121–7.
- Lai Y, Chia Y, Wen C, Hsu H, Chang H, Huang W. Association between risk of neonatal pneumothorax and mode of anesthesia for cesarean delivery at term: a nationwide population-based retrospective cohort study. Int J Obstet Anesth. 2017 May;30:80–1.
- Zanardo V, Padovani E, Pittini C, Doglioni N, Ferrante A, Trevisanuto D. The Influence of Timing of Elective Cesarean Section on Risk of Neonatal Pneumothorax. J Pediatr. 2007 Mar;150(3):252–5.
- 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 Mar 31;88(3):359–61.
- Andersson J, Magnuson A, Ohlin A. Neonatal pneumothorax: symptoms, signs and timing of onset in the post-surfactant era. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec 12;35(25):5438–42.
- Kirby C, Trotter C. Pneumothorax in the Neonate: Assessment and Diagnosis. Neonatal Network. 2005 Sep;24(5):49–55.
- ALTER SJ. Spontaneous pneumothorax in infants: A10-year review. Pediatr Emerg Care. 1997 Dec;13(6):401–3.
- Aly H, Massaro A, Acun C, Ozen M. Pneumothorax in the newborn: clinical presentation, risk factors and outcomes. The Journal of Maternal-Fetal & Neonatal Medicine. 2014 Mar 24;27(4):402–6.
- Papoff P, Moretti C. Pulmonary Air Leakage in Newborns. In: Neonatology. Cham: Springer International Publishing; 2016. p. 1–13.
- Litmanovitz I, Carlo WA. Expectant Management of Pneumothorax in Ventilated Neonates. Pediatrics. 2008 Nov 1;122(5):e975–9.
- Vibede L, Vibede E, Bendtsen M, Pedersen L, Ebbesen F. Neonatal Pneumothorax: A Descriptive Regional Danish Study. Neonatology. 2017;111(4):303–8.
- Wiswell TE, Henley MA. Intratracheal suctioning, systemic infection, and the meconium aspiration syndrome. Pediatrics. 1992 Feb;89(2):203–6.
- Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics. 1990 May;85(5):715–21.
- Prediger B, Mathes T, Polus S, Glatt A, Bühn S, Schiermeier S, et al. A systematic review and time-response meta-analysis of the optimal timing of elective caesarean sections for best maternal and neonatal health outcomes. BMC Pregnancy Childbirth. 2020 Dec 8;20(1):395.
- Ali R, Ahmed S, Qadir M, Maheshwari P, Khan R. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series. Oman Med J. 2013 Jan 16;28(1):67–9.
- 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(3):242–6.
- Joshi A, Kumar M, Rebekah G, Santhanam S. Etiology, clinical profile and outcome of neonatal pneumothorax in tertiary care center in South India: 13 years experience. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Feb 1;35(3):520–4.
- Al Matary A, Munshi HH, Abozaid S, Qaraqei M, Wani TA, Abu-Shaheen AK. Characteristics of Neonatal Pneumothorax in Saudi Arabia: Three Years’ Experience. Oman Med J. 2017 Mar 15;32(2):135–9.
- Abdellatif MAK, Abdellatif DAK. Pneumothorax in the Neonatal Intensive Care Unit in Cairo University Hospital. J Egypt Soc Parasitol. 2012 Aug;42(2):495–506.
- Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: Trends, predictors and outcomes. J Neonatal Perinatal Med. 2014;7(1):29–38.
- Stoll BJ, Kliegman RM. Extrapulmonary extravasation of air. In: Nelson Textbook of Pediatrics. 17th ed. Philadelphia: WB Saunders; 2004. p. 586–7.
- Merenstein GB, Dougherty K, Lewis A. Early detection of pneumothorax by oscilloscope monitor in the newborn infant. J Pediatr. 1972 Jan;80(1):98–101.
- Katar S, Devecioğlu C, Kervancıoğlu M, Ülkü R. Symptomatic spontaneous pneumothorax in term newborns. Pediatr Surg Int. 2006 Sep 3;22(9):755–8.
- Ngerncham S, Kittiratsatcha P, Pacharn P. Risk factors of pneumothorax during the first 24 hours of life. J Med Assoc Thai. 2005 Nov;88 Suppl 8:S135-41.
- Liu J, Chi JH, Ren XL, Li J, Chen YJ, Lu ZL, et al. Lung ultrasonography to diagnose pneumothorax of the newborn. Am J Emerg Med. 2017 Sep;35(9):1298–302.
- Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, et al. Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate. J Pediatr. 2016 Aug;175:74-78.e1.
- Fei Q, Lin Y, Yuan TM. Lung Ultrasound, a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis. Ultrasound Med Biol. 2021 Mar;47(3):359–69.
- Smith J, Schumacher R, Donn S, Sarkar S. Clinical Course of Symptomatic Spontaneous Pneumothorax in Term and Late Preterm Newborns: Report from a Large Cohort. Am J Perinatol. 2011 Feb 10;28(02):163–8.
- Melekoğlu N, Sinanoğlu MS, Berk E. Evaluation of pneumothorax in the neonatal intensive care unit. Mustafa Kemal Üniversitesi Tıp Dergisi. 2022 Aug 1;13(46):168–73.
- Okumuş M, Zubarioğlu AU. Neonatal Pneumothorax - 10 Years of Experience From a Single Center. The Journal of Pediatric Research. 2020 May 14;7(2):163–7.
- Ilçe Z, Gündogdu G, Kara C, Ilikkan B, Celayir S. Which patients are at risk? Evaluation of the morbility and mortality in newborn pneumothorax. Indian Pediatr. 2003 Apr;40(4):325–8.
- Kitsommart R, Martins B, Bottino MN, Sant’Anna GM. Expectant Management of Pneumothorax in Preterm Infants Receiving Assisted Ventilation: Report of 4 Cases and Review of the Literature. Respir Care. 2012 May;57(5):789–93.
- Pocivalnik M, Meheden S, Griesmaier E, Trawöger R, Kiechl-Kohlendorfer U, Pichler G, et al. Pneumothorax unter Beatmung – ein Vergleich möglicher Therapieoptionen bei Reif- und Frühgeborenen. Klin Padiatr. 2013 Oct 24;225(07):389–93.
- Murphy MC, Heiring C, Doglioni N, Trevisanuto D, Blennow M, Bohlin K, et al. Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns: A Randomized Clinical Trial. JAMA Pediatr. 2018 Jul 1;172(7):664–9.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Çocuk Göğüs Hastalıkları |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 8 Eylül 2025 |
| Gönderilme Tarihi | 18 Aralık 2024 |
| Kabul Tarihi | 2 Haziran 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 64 Sayı: 3 |
