Pneumothorax is a collection of air between the lung and the chest wall that develops when air leaks out of the lung.
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.
(See also Overview of General Problems in Newborns and Pneumothorax.)
Pneumothorax most often occurs in newborns with stiff lungs, such as newborns who have respiratory distress syndrome (especially if due to prematurity) or meconium aspiration syndrome.
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. In these cases, pneumothorax is usually an incidental finding and these infants usually do not need any treatment.
Some newborns who have a pneumothorax develop another lung disorder called persistent pulmonary hypertension.
Other air-leak syndromes
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. Pneumomediastinum is usually only discovered when the infant has a chest x-ray for an unrelated issue.
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). Pneumopericardium and pneumoperitoneum are medical emergencies. Pulmonary interstitial emphysema may require changes in ventilator settings. Subcutaneous emphysema does not require additional treatment.
Symptoms of Pneumothorax in the Newborn
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). In newborns of color, the skin may change to colors such as yellow-gray, gray, or white. These changes may be more easily seen in the mucous membranes lining the inside of the mouth, nose, and eyelids.
The chest on the affected side is sometimes more prominent than the unaffected side.
Diagnosis of Pneumothorax in the Newborn
Positive transillumination
Chest x-ray
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.
Treatment of Pneumothorax in the Newborn
Oxygen
Sometimes removal of air from the chest cavity
No treatment is needed for newborns who do not have symptoms and who have a small pneumothorax.
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.
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 have serious breathing trouble, 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 requires no treatment.
