Pneumothorax
Pneumothorax is a collection of air within the chest cavity surrounding a lung that develops when air leaks out of the lung.
Pneumothorax most often occurs in a newborn with stiff lungs, such as a newborn with respiratory distress syndrome or meconium aspiration syndrome. Occasionally, it occurs as a complication from the use of continuous positive airway pressure (CPAP) or a ventilator. If the pneumothorax is under pressure, it can result in collapse of the lung and in difficulty breathing. Also, if under pressure, the pneumothorax can compress the veins bringing blood to the heart. As a result, less blood fills the chambers of the heart, the output of the heart decreases, and the newborn's blood pressure decreases.
Air that leaks from the lungs into the soft tissues in front of the heart is called pneumomediastinum. Unlike pneumothorax, this condition usually does not affect breathing.
Diagnosis and Treatment
Pneumothorax is suspected when a newborn with underlying lung disease, or a newborn on continuous positive airway pressure (CPAP) or a ventilator, develops worsening respiratory distress or a drop in blood pressure. When examining the newborn, a doctor notices a diminished sound of air entering and leaving the lung on the side of the pneumothorax. In premature newborns, a fiber-optic light may be used to light up the affected side of the newborn's chest while in a darkened room (positive transillumination); this procedure is used to look for air in the pleural cavity. A chest x-ray provides a definitive diagnosis.
No treatment is needed in newborns who do not have symptoms. A term newborn with mild symptoms may be placed in an oxygen hood. However, if the newborn's breathing is labored, and particularly if the circulation of blood is impaired, the air must be rapidly removed from the pleural cavity, which can be done using a needle and syringe. If the newborn is in significant distress, is receiving CPAP, or is on a ventilator, a doctor may need to place a chest tube 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; no treatment is needed.
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