Clinical profile and outcome of neonatal pneumothorax in resource-limited neonatal intensive care unit

Abstract

Objective of study To determine the frequency, clinical profile, and outcome of pneumothoraxes in neonates in resource-limited neonatal intensive care unit (NICU) setting. Study design Prospective cohort. Place and duration of study The study was carried over a period of 4 years and 6 months at two NICUs of Combined Military Hospital (CMH) Multan (January 2011–August 2013) and CMH Abbottabad (September 2013–July 2015). Materials and methods All neonates fulfilling inclusion criteria were included in the study. Demographic and clinical parameters were recorded. All stable cases were initially managed on headbox oxygen, nasal oxygen, or improvised bubble continuous positive airway pressure devices (B-CPAP). In suspected cases, pneumothorax was confirmed on a portable chest X-Ray (CXR). Hemodynamically stable neonates were closely observed for spontaneous resolution whereas unstable neonates were managed by needle thoracocentesis or thoracostomy with or without ventilator support. End point of the study was either discharge or death of the neonate. Results Of a total of 1427 included neonates, 66 (4.6%) developed pneumothorax. Pneumothorax was more common in late pre-term and term infants with normal birth weight (>2.5 kg). Primary diseases leading to pneumothorax were respiratory distress syndrome (RDS) 38 (57.6%), meconium aspiration syndrome (MAS) 10 (15.2%), transient tachypnea of newborn (TTN) 9 (13.6%), birth asphyxia syndrome (BAS) 6 (9.1%), and pneumonia 3 (4.5%). Majority of the patients 58 (87.9%), required thoracostomy, 2 (3%) required only needle thoracocentesis while spontaneous resolution occurred in 6 (9.1%) patients. Out of 66 patients, 48 (72.7%) were discharged and 18 (27.3%) died. Average hospital stay was 10.5 ± 5.85 days. Conclusion Pneumothorax is not an uncommon complication in neonates presenting with respiratory distress in resource-limited NICUs. High index of suspicion is required for early recognition and timely management, as delay is associated with significant mortality.