Pneumothorax in the Newborn
This disorder may develop in newborns who have lung disorders such as respiratory distress syndrome or meconium aspiration syndrome, who are treated with continuous positive airway pressure (CPAP), or who are using a ventilator.
The lung may collapse, breathing may be difficult, and blood pressure may decrease.
The diagnosis is based on presence of breathing trouble, the results of a chest x-ray, and usually on the amount of oxygen and carbon dioxide in the newborn's blood.
Newborns who have trouble breathing are given oxygen, and air sometimes is removed from the chest cavity using a needle and syringe or a plastic drainage tube that is left in place.
Infrequently, it occurs as a complication resulting from the use of continuous positive airway pressure (CPAP—a technique that allows newborns to breathe on their own while receiving slightly pressurized air or oxygen) or a ventilator (a machine that helps air get in and out of the lungs). A pneumothorax can result in collapse of the lung and difficulty breathing. If enough air accumulates in the space between the lung and the chest wall, the veins that bring blood to the heart can be compressed. As a result, less blood fills the chambers of the heart, the output of the heart decreases, and the newborn’s blood pressure decreases.
Pneumothorax can occasionally happen spontaneously in newborns who do not have underlying lung disorders or who do not need breathing support. Some newborns who have a pneumothorax develop another lung disorder called persistent pulmonary hypertension.
Air can leak out of the lungs and into other tissues. These disorders are called air-leak syndromes.
Air that leaks from the lungs into the tissues in the center of the chest is called pneumomediastinum. Unlike pneumothorax, this condition usually does not affect breathing and does not require treatment.
Other air-leak syndromes include pulmonary interstitial emphysema (air in the tissues of the lungs between the air sacs), pneumopericardium (air in the sac around the heart), and, rarely, pneumoperitoneum (air in the abdominal cavity) and subcutaneous emphysema (air under the skin).
Pneumothorax in the newborn sometimes causes no symptoms. However, it can be the cause of a newborn’s rapid breathing. Newborns also may grunt when breathing out and may have a bluish color to their skin and/or lips (cyanosis). The chest on the affected side is sometimes more prominent than the unaffected side.
Because many newborns have no symptoms, pneumothorax is suspected when newborns who have underlying lung disorders or newborns who are receiving CPAP or are on a ventilator develop worsening trouble breathing (respiratory distress), a drop in blood pressure, or both. When examining these newborns, doctors may notice diminished sounds of air entering and leaving the lung on the side of the pneumothorax.
In premature newborns, doctors sometimes shine a fiber-optic light through the affected side of the newborn’s chest while in a darkened room (transillumination). This procedure is done to show free air in the area surrounding the lungs (pleural cavity). A chest x-ray confirms the diagnosis of pneumothorax in the newborn.
No treatment is needed for newborns who do not have symptoms.
Full-term newborns who have mild symptoms may be placed in a small tent into which oxygen is pumped (an oxygen hood) or receive oxygen via a two-pronged tube placed in the nostrils so that they breathe air that contains more oxygen than the air in the room does. The amount of oxygen given is typically enough to maintain adequate oxygen levels in the blood. However, if the newborn’s breathing is labored or if the level of oxygen in the blood declines, and particularly if the circulation of blood is impaired, the air must be rapidly removed from the chest cavity. Air is removed from the chest cavity by using a needle and syringe. For newborns who are having serious respiratory distress, who are receiving CPAP, or who are on a ventilator, doctors may need to place a plastic tube into the chest cavity to continuously suction and remove air from the chest cavity. The tube can usually be removed after several days.
A pneumomediastinum can be seen on an x-ray and requires no treatment.