What is pneumothorax?

A pneumothorax is the accumulation of air in the cavity between the lungs and the chest wall (termed the pleural space), which can lead to a lung collapse.

Who is affected and what are the risk factors?

Babies with other lung diseases such as respiratory distress syndrome (RDS) or lung infection (pneumonia), babies on mechanical ventilators, preterm babies whose lung tissues are immature and vulnerable, and babies with meconium aspiration (when a newborn inhales/ aspirates a mixture of meconium and amniotic fluid) are most at risk to develop a pneumothorax. Pneumothorax may occur in about five to seven percent of babies with birth weight of less than 1,500 g.

What is the cause?

A pneumothorax occurs when tiny air sacs (alveoli) in the infant's lung become overinflated and rupture. Air then tracks through the lung tissue and enters to pleural space.  Normally there is no air in this space and its presence allows the lung itself to fall away from the chest wall and sometimes collapse. For some babies there is little sign this has occurred,  while others can sudenly become very ill.

How is it diagnosed?

The medical team may be alerted by signs of a pneumothorax, such as a sudden decrease of the oxygen saturation in the blood or a drop in blood pressure or heart rate. A pneumothorax can in some cases be seen by shining a bright light through the tissue of the infant’s chest. Usually, a pneumothorax is diagnosed by chest X-ray.

How is it managed?

The size of the rupture mainly determines the treatment strategy for a pneumothorax. Sometimes, it is possible to remove the air with a needle and the rupture may close on its own. More often, a special tube called a ‘chest drain’ is inserted between the ribs to allow the continuous removal of the air. When the pneumothorax has resolved the drain can be removed safely.

Additionally, it can be necessary to give supplemental oxygen to the baby and gently ventilate. Sometimes, high frequency oscillatory ventilation (HFOV) is used and antibiotics may be administered to reduce the risk of a lung infection.

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