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Donda K, Babu S, Rastogi D, Rastogi S. Risk Factors for Pneumothorax and Its Association with Ventilation in Neonates. Am J Perinatol 2024; 41:e1531-e1538. [PMID: 37072012 DOI: 10.1055/s-0043-1768070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE The mode of ventilation that is implicated in pneumothorax is the one at the time of its diagnosis. Although there is evidence that air leak starts many hours before it is clinically evident, there are no prior studies that have investigated the association of pneumothorax with the mode of ventilation few hours before rather than at the time of its diagnosis. STUDY DESIGN A retrospective case-control study was conducted in the neonatal intensive care unit (NICU) between 2006 and 2016 where cases of neonates with pneumothorax were compared with gestational age-matched control neonates without pneumothorax. Respiratory support associated with pneumothorax was classified as the mode of ventilation 6 hours before the clinical diagnosis of pneumothorax. We investigated the factors that were different between cases and controls, and between cases of pneumothorax on bubble continuous positive airway pressure (bCPAP) and invasive mechanical ventilation (IMV). RESULT Of the 8,029 neonates admitted in the NICU during the study period, 223 (2.8%) developed pneumothorax. Among these, 127 occurred among 2,980 (4.3%) neonates on bCPAP, 38 among 809 (4.7%) neonates on IMV, and the remaining 58 among 4,240 (1.3%) neonates on room air. Those with pneumothorax were more likely to be male, have higher body weight, require respiratory support and surfactant administration, and have bronchopulmonary dysplasia (BPD). Among those who developed pneumothorax, there were differences in the gestational age, gender, and use of antenatal steroids between those who were on bCPAP as compared to those on IMV. IMV was associated with increased odds of pneumothorax as compared to those on bCPAP in a multivariable regression analysis. Cases on IMV had higher incidence of intraventricular hemorrhage, retinopathy of prematurity, BPD, and necrotizing enterocolitis, as well as longer length of stay as compared to those on bCPAP. CONCLUSION Neonates who require any respiratory support have higher incidence of pneumothorax. Among those on respiratory support, those on IMV had higher odds of pneumothorax and worse clinical outcomes as compared to those on bCPAP. KEY POINTS · The process of air leak leading to pneumothorax in majority of neonates starts much before it is clinically diagnosed.. · It is possible to detect the air leak early in the process by subtle changes in the signs, symptoms and changes in lung function.. · True association of the ventilation associated with pneumothorax is not at the time of diagnosis of pneumothorax but few hours before it is diagnosed.. · There is higher incidence of pneumothorax in neonates on any respiratory support.. · There is significantly higher incidence of pneumothorax among neonates on invasive ventilations as compared to noninvasive ventilation after correction for all other clinical factors..
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Affiliation(s)
- Keyur Donda
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sharmila Babu
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
| | - Deepa Rastogi
- Division of Pulmonary Medicine, Childrens National Hospital George Washington University, Washington, District of Columbia
| | - Shantanu Rastogi
- Division of Neonatology, Childrens National Hospital George Washington University, Washington, District of Columbia
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Salazar EG, Passarella M, Formanowski B, Phibbs CS, Lorch SA, Handley SC. The impact of volume and neonatal level of care on outcomes of moderate and late preterm infants. J Perinatol 2024:10.1038/s41372-024-01901-x. [PMID: 38413758 DOI: 10.1038/s41372-024-01901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Evaluate the relationship of neonatal unit level of care (LOC) and volume with mortality or morbidity in moderate-late preterm (MLP) (32-36 weeks' gestation) infants. DESIGN Retrospective cohort study of 650,865 inborn MLP infants in 4976 hospitals-years using 2003-2015 linked administrative data from 4 states. Exposure was combined neonatal LOC and MLP annual volume. The primary outcome was death or morbidity (respiratory distress syndrome, severe intraventricular hemorrhage, necrotizing enterocolitis, sepsis, infection, pneumothorax, extreme length of stay) with components as secondary outcomes. Poisson regression models adjusted for patient characteristics with a random effect for unit were used. RESULTS In adjusted models, high-volume level 2 units had a lower risk of the primary outcome compared to low-volume level 3 units (aIRR 0.90 [95% CI 0.83-0.98] vs. aIRR 1.13 [95% CI 1.03-1.24], p < 0.001) CONCLUSION: MLP infants had improved outcomes in high-volume level 2 units compared to low-volume level 3 units in adjusted analysis.
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Affiliation(s)
- Elizabeth G Salazar
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Molly Passarella
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brielle Formanowski
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ciaran S Phibbs
- Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sara C Handley
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Masahata K, Nagata K, Terui K, Kondo T, Ebanks AH, Harting MT, Buchmiller TL, Sato Y, Okuyama H, Usui N. Risk Factors for Preoperative Pneumothorax in Neonates With Isolated Left-Sided Congenital Diaphragmatic Hernia: An International Cohort Study. J Pediatr Surg 2024:S0022-3468(24)00048-4. [PMID: 38388286 DOI: 10.1016/j.jpedsurg.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/30/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND We aimed to investigate the clinical characteristics and outcomes of patients with isolated left-sided congenital diaphragmatic hernia (CDH) who developed preoperative pneumothorax and determine its risk factors. METHODS We performed an international cohort study of patients with CDH enrolled in the Congenital Diaphragmatic Hernia Study Group registry between January 2015 and December 2020. The main outcomes assessed included survival to hospital discharge and preoperative pneumothorax development. The cumulative incidence of pneumothorax was estimated by the Gray test. The Fine and Gray competing risk regression model was used to identify the risk factors for pneumothorax. RESULTS Data for 2858 neonates with isolated left-sided CDH were extracted; 224 (7.8%) developed preoperative pneumothorax. Among patients with a large diaphragmatic defect, those with pneumothorax had a significantly lower rate of survival to discharge than did those without. The competing risks model demonstrated that a patent ductus arteriosus with a right-to-left shunt flow after birth (hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.21-2.63; p = 0.003) and large defects (HR: 1.65; 95% CI: 1.13-2.42; p = 0.01) were associated with an increased risk of preoperative pneumothorax. Significant differences were observed in the cumulative incidence of pneumothorax depending on defect size and shunt direction (p < 0.001). CONCLUSIONS Pneumothorax is a significant preoperative complication associated with increased mortality in neonates with CDH, particularly in cases with large defects. Large diaphragmatic defects and persistent pulmonary hypertension were found to be risk factors for preoperative pneumothorax development. LEVEL OF EVIDENCE LEVEL Ⅲ Retrospective Comparative Study.
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Affiliation(s)
- Kazunori Masahata
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan; Department of Pediatric Surgery, Aizenbashi Hospital, Osaka, Japan
| | - Kouji Nagata
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuya Kondo
- Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan
| | - Ashley H Ebanks
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan.
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Baudat-Nguyen J, Schneider J, Roth-Kleiner M, Barrielle L, Diebold P, Duvoisin G, El Faleh I, Gruppe S, Huber BM, Morel AS, Paccaud Y, Torregrossa A, Younes D, Tolsa JF, Truttmann AC. Incidence and Management of Neonatal Pneumothorax in a 10-Hospital Regional Perinatal Network in Switzerland: A Retrospective Observational Study. Am J Perinatol 2023. [PMID: 38154466 DOI: 10.1055/s-0043-1777861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Pneumothorax (PTX) is a potentially life-threatening condition that affects neonates, with an incidence of 0.05 to 2%. Its management includes conservative treatment, chest tube (CT) drainage, and needle aspiration (NA). Aims were to evaluate the incidence of PTX in a 10-hospital perinatal network, its clinical characteristics and risk factors, and to compare the different treatment options. STUDY DESIGN All neonates diagnosed with PTX and hospitalized in the network were included in this retrospective observational trial over a period of 30 months. Primary outcome was the incidence of PTX. Secondary outcomes were the treatment modality, the length of stay (LOS), and the number of chest X-rays. RESULTS Among the 173 neonates included, the overall incidence of PTX was 0.56 per 100 births with a large range among the hospitals (0.12-1.24). Thirty-nine percent of pneumothoraces were treated conservatively, 41% by CT drainage, 13% by NA, and 7% by combined treatment. Failure rate was higher for NA (37%) than for CT drainage (9%). However, the number of X-rays was lower for patients treated by NA, with a median of 6 (interquartile range [IQR] 4-6.25), than by CT drainage, with a median of 9 (IQR 7-12). LOS was shorter for NA than for CT drainage, with a median of 2 (IQR 1-4.25) and 6 days (IQR 3-15), respectively. Complications, including apnea and urinary retention, occurred in 28% of patients managed with CT drainage, whereas none was observed with NA. CONCLUSION High variability of PTX incidence was observed among the hospitals within the network, but these values correspond to the literature. NA showed to reduce the number of X-rays, the LOS, and complications compared with CT drainage, but it carries a high failure rate. This study helped provide a new decisional management algorithm to harmonize and improve PTX treatment within our network. KEY POINTS · Neonatal pneumothorax (PTX) is a frequent pathology with a high incidence requiring urgent management.. · We report a large variability of PTX incidence between different hospitals of the same network.. · Needle aspiration carries higher failure rate, shorter hospital stay duration without complications reported..
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Affiliation(s)
- Julie Baudat-Nguyen
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Juliane Schneider
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Roth-Kleiner
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Laureline Barrielle
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Patrick Diebold
- Department of Pediatrics, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Gilles Duvoisin
- Department of Pediatrics, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Ikbel El Faleh
- Department of Pediatrics, Neuchâtel Hospital, Neuchâtel, Switzerland
| | - Silke Gruppe
- Department of Pediatrics, Yverdon Hospital, Yverdon, Switzerland
| | - Benedikt M Huber
- Department of Pediatrics, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | | | - Yan Paccaud
- Clinic of Pediatrics, Hospital Center of Valais Romand, Hospital of Valais, Sion, Switzerland
| | - Anais Torregrossa
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Pediatrics, Morges Hospital, Morges, Switzerland
| | - Dany Younes
- Department of Pediatrics, De la Broye Intercantonal Hospital, Payerne, Switzerland
| | - Jean-François Tolsa
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Anita C Truttmann
- Department Women-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Oh SH, Jin HS, Park CH. Risk factors and neonatal outcomes of pulmonary air leak syndrome in extremely preterm infants: A nationwide descriptive cohort study. Medicine (Baltimore) 2023; 102:e34759. [PMID: 37653823 PMCID: PMC10470716 DOI: 10.1097/md.0000000000034759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023] Open
Abstract
Most extremely preterm infants (EPIs), who were born before 28 weeks of gestation, with pulmonary air leak syndrome (ALS) are symptomatic, often severe, and require drainage. EPIs with severe air leak syndrome (sALS) that require tube drainage or needle aspiration are at high risk of morbidities and mortality. This study aimed to investigate perinatal characteristics, morbidities, and mortality in EPIs with sALS, and to estimate the risk of mortality according to gestational age (GA). A prospective cohort study conducted from 2013 to 2020 compiled the Korean Neonatal Network database to evaluate the incidence, perinatal characteristics, and outcomes of sALS in EPIs born before 28 weeks of gestation. Among 5666 EPIs, the incidence of sALS was 9.4% and inversely related to GA. From this cohort, we compared 532 EPIs with sALS to 1064 EPIs without sALS as controls, matching the subjects by GA and birth weight. Preterm premature rupture of membranes, oligohydramnios, resuscitation after birth, low Apgar scores, repeated surfactant administration, persistent pulmonary hypertension of the newborn, and pulmonary hemorrhage were associated with the development of pneumothorax. The sALS group required a higher fraction of inspired oxygen and more invasive respiratory support at both 28 days of life and 36 weeks of postmenstrual age. The sALS group had a higher incidence of bronchopulmonary dysplasia and major brain injury. The mortality rate was higher in the sALS group than in the control group (55.3% vs 32.5%, P < .001), and the ALS group had a 1.7 times risk of mortality than the control group. More attention should be paid to sALS in EPIs because the frequency of sALS increased as GA decreased, and the risk of mortality was more significant at lower GA.
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Affiliation(s)
- Seong Hee Oh
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
- Department of Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyun-Seung Jin
- Department of Pediatrics, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
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Rojas-García A, Moreno-Blanco D, Otero-Arteseros M, Rubio-Bolívar FJ, Peinado H, Elorza-Fernández D, Gómez EJ, Quintana-Díaz M, Sánchez-Gonzalez P. SIMUNEO: Control and Monitoring System for Lung Ultrasound Examination and Treatment of Neonatal Pneumothorax and Thoracic Effusion. SENSORS (BASEL, SWITZERLAND) 2023; 23:5966. [PMID: 37447813 DOI: 10.3390/s23135966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for clinicians can potentially compromise patient safety, as they may not be adequately prepared to handle real-life situations independently. Clinical simulators help to solve this problem by providing real-world scenarios in which the physicians can train and gain confidence by safely and repeatedly practicing different techniques. In addition, obtaining objective feedback allows subsequent debriefing by analysing the situation experienced and learning from other people's mistakes. This article presents SIMUNEO, a neonatal simulator in which professionals are able to learn by practicing the management of lung ultrasound and the resolution of pneumothorax and thoracic effusions. The article also discusses in detail the hardware and software, the main components that compose the system, and the communication and implementation of these. The system was validated through both usability questionnaires filled out by neonatology residents as well as through follow-up sessions, improvement, and control of the system with specialists of the department. Results suggest that the environment is easy to use and could be used in clinical practice to improve the learning and training of students as well as the safety of patients.
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Affiliation(s)
- Adriana Rojas-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Diego Moreno-Blanco
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Martin Otero-Arteseros
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Helena Peinado
- Servicio de Neonatología, Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
| | | | - Enrique J Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Manuel Quintana-Díaz
- CEASEC-Fundación para la Investigación Biomédica del Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
- Servicio de Medicina Intensiva, Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
| | - Patricia Sánchez-Gonzalez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
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Mosalli R. Clinical Profile and Outcome of Neonatal Pneumothorax: Seven Years of Experience in a Tertiary Care Center. Cureus 2023; 15:e37625. [PMID: 37200634 PMCID: PMC10185488 DOI: 10.7759/cureus.37625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Neonatal pneumothorax (NP) in neonates is a medical emergency with a significant incidence of morbidity and mortality. There is a paucity of national and regional data about the epidemiological and clinical profiles of pneumothorax. AIM The study aim is to identify the demographics, predisposing factors, clinical profiles, and outcomes of NP in a tertiary neonatal care center in Saudi Arabia. METHODS A retrospective study of all newborns admitted at the neonatal intensive care unit at International Medical Centre, Jeddah, Saudi Arabia, over seven years period between January 2014 and December 2020 was reviewed. A total of 3,629 newborns admitted to the neonatal intensive care unit were included in the study. Data collected included baseline characteristics, predisposing factors, associated morbidities, management, and outcomes of NP. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). RESULTS Of a total of 3,692 included neonates, pneumothorax was detected in 32 neonates with an incidence of 1.02% (ranging from 0.69% to 2%), and 53.1% were males. The mean gestational age was 32 weeks. Our study found that most infants with pneumothorax were extremely low birth weight (ELBW) in 19 babies (59%). The most common predisposing factors were respiratory distress syndrome in 31 babies (96.9%) followed by the need for bag-mask ventilation in 26 babies (81.3%). Twelve newborns (37.5%) with pneumothorax died. Following an analysis of all risk variables, the one-minute Apgar score <5, associated intraventricular hemorrhage, and respiratory support need were shown to be significantly linked with death. CONCLUSION Pneumothorax is not an uncommon neonatal emergency event, especially for ELBW infants, infants requiring respiratory support, or infants with underlying lung disease. Our study describes the clinical profile and affirms the significant burden of NP.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, Umm Al-Qura University, Makkah, SAU
- Department of Pediatrics, International Medical Center, Jeddah, SAU
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Halibullah I, Hammond F, Hodgson K, Duffy N, Stewart M, Sett A. Management of pneumothorax in neonatal retrieval: a retrospective cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:182-187. [PMID: 36167779 DOI: 10.1136/archdischild-2022-324352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Management of pneumothorax in neonates requiring retrieval poses unique challenges, including decision to insert an intercostal catheter (ICC). We aimed to report the proportion and characteristics of neonates transported with and without ICC insertion and the incidence of deterioration in neonates transported with pneumothorax. METHODS A retrospective cohort study of neonates transported with pneumothorax between 2016 and 2020 in Victoria, Australia. Univariate analysis was performed on patient and clinical characteristics, followed by multivariate analysis to identify risks independently associated with ICC insertion. RESULTS 174 neonates were included. Mean (SD) gestational age (GA) was 37.5 (2.8) weeks. Eighty-two neonates (47%) had ICC inserted. On multivariate analysis, risk factors independently associated with ICC insertion were mechanical ventilation (MV) preceding retrieval team arrival (OR 12, 95% CI 3.1 to 46.6, p<0.001) and radiographical mediastinal shift (MS) (OR 6.2, 95% CI 2.4 to 16.2, p<0.001). Increasing GA is negatively associated with ICC insertion (OR 0.66, 95% CI 0.5 to 0.8, p<0.001). No significant difference in incidence of deterioration between the ICC group and the no-ICC group was observed (8.5% vs 5.4%, p=0.55). Ninety-five neonates were treated with needle aspiration (NA); 40 (42%) subsequently avoided ICC insertion. Twelve (13%) neonates transported without ICC had insertion within 24 hours following transport. CONCLUSION Many neonates with pneumothorax are transported without ICC, with low incidence of deterioration and ICC insertion within 24 hours after transport. More than a third of neonates managed with NA avoided ICC insertion. The likelihood of ICC insertion is increased by lower GA, MV prior to retrieval team arrival and radiographical MS.
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Affiliation(s)
- Ikhwan Halibullah
- Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Fiona Hammond
- Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Kate Hodgson
- Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Melbourne, Australia
| | - Natalie Duffy
- Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Stewart
- Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Australia
| | - Arun Sett
- Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Melbourne, Australia.,Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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9
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Montero Gato J, Sacristán PA, Vázquez NL, Martín MDLH, Amorós AG, Fernández LR. Incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates. Pediatr Pulmonol 2023; 58:1691-1696. [PMID: 36852449 DOI: 10.1002/ppul.26378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Pneumothorax in neonates can be life-threatening. In neonates without respiratory distress, spontaneous pneumothorax can also develop under certain conditions. OBJECTIVES To determine the incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates using lung ultrasound as the diagnostic tool. METHODS This was an observational prospective study conducted at the Basurto University Hospital (Bilbao, Spain) between January 2018 and December 2020. Lung ultrasound was performed during routine examination of asymptomatic neonates admitted to the maternity ward. RESULTS Of a total of 204 asymptomatic neonates included in the study, 21 (10.3%) presented ultrasound signs of pneumothorax (Group A), and 183 (89.7%) had a normal lung ultrasound (Group B). Lung ultrasound was performed after a mean of 19 h of life (range 9-34). The presence of A-lines behind the sternum in the anterior transverse plane, at the intermammillary level, was observed in 100% of patients in Group A compared to no cases in Group B (p < 0.0001). The neonates of Group A presented the lung point located in the midclavicular line, indicative of a mild air leak. CONCLUSIONS Lung ultrasound allows precise detection of suspected small-sized air leaks that can be detected in asymptomatic neonates. The true incidence of pneumothorax in asymptomatic neonates may be substantially higher than previously described in the literature.
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Affiliation(s)
| | | | | | | | | | - Lorena Rodeño Fernández
- Neonatology Unit, University Hospital Basurto, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
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10
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Demographic and clinical characteristics of newborn pneumothorax patients and their effects on respiratory function tests during childhood. Pediatr Surg Int 2023; 39:134. [PMID: 36808296 DOI: 10.1007/s00383-023-05416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE Pneumothorax is defined as the presence of air between the parietal and visceral leaves of the pleura, resulting in lung collapse. The aim of this study was to evaluate the respiratory functions of these patients when they reach school age and to reveal whether they cause permanent respiratory pathology. METHODS The files of 229 patients who were hospitalised in a neonatal intensive care clinic had received a diagnosis of pneumothorax and had undergone tube thoracostomy were included in a retrospective cohort review. The respiratory functions of participants in the control and patient groups were evaluated using spirometry in a prospective cross-sectional study design. RESULTS The study found the rates of pneumothorax to be higher in males, term infants and after caesarean delivery, mortality was 31%. Among patients who underwent spirometry, those with a history of pneumothorax had lower forced expiratory volume at timed intervals of 0.5 to 1.0 (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow (PEF) and forced expiratory flow 25-75% (MEF25-75). FEV1/FVC ratio was significantly lower (p < 0.05). CONCLUSION Patients treated for pneumothorax in the neonatal period should be evaluated for obstructive pulmonary diseases during childhood using respiratory function tests.
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Zhang X, Zhang N, Ren YY. Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax. World J Clin Cases 2022; 10:12066-12076. [PMID: 36483838 PMCID: PMC9724522 DOI: 10.12998/wjcc.v10.i33.12066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.
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Affiliation(s)
- Xu Zhang
- Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Ning Zhang
- Department of Clinical Laboratory, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Yue-Yi Ren
- Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
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Measuring quality of care in moderate and late preterm infants. J Perinatol 2022; 42:1294-1300. [PMID: 35354940 PMCID: PMC9522891 DOI: 10.1038/s41372-022-01377-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/22/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine quality measures for moderate and late preterm (MLP) infants. STUDY DESIGN By prospectively analyzing Vermont Oxford Network's all NICU admissions database, we adapted Baby-MONITOR, a composite quality measure for extremely/very preterm infants, for MLP infants. We examined correlations between the adapted MLP quality measure (MLP-QM) in MLP infants and Baby-MONITOR in extremely and very preterm infants. RESULT We studied 376,219 MLP (30-36 weeks GA) and 57,595 extremely/very preterm (25-29 weeks GA) infants from 465 U.S. hospitals born from 2016 to 2020. MLP-QM summary scores in MLP infants had weak correlation with Baby-MONITOR scores in extremely and very preterm infants (r = 0.47). There was weak correlation among survival (r = 0.19), no pneumothorax (r = 0.35), and no infection after 3 days (r = 0.45), but strong correlation among human milk at discharge (r = 0.79) and no hypothermia (r = 0.76). CONCLUSION Modest correlation among hospital care measures in two preterm populations suggests the need for MLP-specific care measures.
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Mahmood B. Persistent pulmonary hypertension of newborn. Semin Pediatr Surg 2022; 31:151202. [PMID: 36038220 DOI: 10.1016/j.sempedsurg.2022.151202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Burhan Mahmood
- Division of Newborn Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pennsylvania, USA.
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Handley SC, Salazar EG, Greenberg LT, Foglia EE, Lorch SA, Edwards EM. Variation and Temporal Trends in Delivery Room Management of Moderate and Late Preterm Infants. Pediatrics 2022; 150:188540. [PMID: 35851607 PMCID: PMC9721105 DOI: 10.1542/peds.2021-055994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although delivery room (DR) intervention decreases with increasing gestational age (GA), little is known about DR management of moderate and late preterm (MLP) infants. METHODS Using the Vermont Oxford Network database of all NICU admissions, we examined the receipt of DR interventions including supplemental oxygen, positive pressure ventilation, continuous positive airway pressure, endotracheal tube ventilation, chest compressions, epinephrine, and surfactant among MLP infants (30 to 36 weeks') without congenital anomalies born from 2011 to 2020. Pneumothorax was examined as a potential resuscitation-associated complication. Intervention frequency was assessed at the infant- and hospital-level, stratified by GA and over time. RESULTS Overall, 55.3% of 616 110 infants (median GA: 34 weeks) from 483 Vermont Oxford Network centers received any DR intervention. Any DR intervention frequency decreased from 89.7% at 30 weeks to 44.2% at 36 weeks. From 2011 to 2020, there was an increase in the provision of continuous positive airway pressure (17.9% to 47.8%, P ≤.001) and positive pressure ventilation (22.9% to 24.9%, P ≤.001) and a decrease in endotracheal tube ventilation (6.9% to 4.0% P ≤.001), surfactant administration (3.5% to 1.3%, P ≤.001), and pneumothorax (1.9% to 1.6%, P ≤.001). Hospital rates of any DR intervention varied (median 54%, interquartile range 47% to 62%), though the frequency was similar across hospitals with different NICU capabilities after adjustment. CONCLUSIONS The DR management of MLP infants varies at the individual- and hospital-level and is changing over time. These findings illustrate the differing interpretation of resuscitation guidelines and emphasize the need to study MLP infants to improve evidence-based DR care.
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Affiliation(s)
- Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA;,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;,Leonard Davis Institute of Health Economics, Philadelphia, PA
| | - Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA;,Leonard Davis Institute of Health Economics, Philadelphia, PA
| | - Lucy T. Greenberg
- Vermont Oxford Network, Burlington, VT;,Department of Mathematics and Statistics, The University of Vermont, Burlington, VT
| | - Elizabeth E. Foglia
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA;,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA;,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;,Leonard Davis Institute of Health Economics, Philadelphia, PA
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington, VT;,Department of Pediatrics, The Robert Larner MD, College of Medicine, The University of Vermont, Burlington, VT;,Department of Mathematics and Statistics, The University of Vermont, Burlington, VT
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Jovandaric MZ, Milenkovic SJ, Dotlic J, Babovic IR, Jestrovic Z, Milosevic B, Culjic M, Babic S. Neonatal Pneumothorax Outcome in Preterm and Term Newborns. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070965. [PMID: 35888683 PMCID: PMC9320446 DOI: 10.3390/medicina58070965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Pneumothorax implies the presence of air in the pleural space between the visceral and parietal pleura. The aim of this study was to investigate the incidence, clinical characteristics, risk factors, therapy and perinatal outcome in neonates with pneumothorax in a tertiary care center. Materials and Methods: A retrospective study based on a five-year data sample of neonates with pneumothorax was conducted in a Maternity Hospital with a tertiary NICU from 2015 to 2020. We included all neonates with pneumothorax born in our hospital and compared demographic characteristics, perinatal risk factors, anthropometric parameters, comorbidities, clinical course and method of chest drainage between term (≥37 GW) and preterm (<37 GW) neonates. Results: The study included 74 newborns with pneumothorax, of which 67.6% were male and 32.5% were female. The majority of women (59.5%) had no complications during pregnancy. Delivery was mainly performed via CS (68.9%). Delivery occurred on average in 34.62 ± 4.03 GW. Significantly more (p = 0.001) children with pneumothorax were born prematurely (n = 53; 71.6%) than at term (n = 21; 28.4%). Most of the neonates had to be treated with ATD (63.5%) and nCPAP (39.2%), but less often they were treated with surfactant (40.5%) and corticosteroids (35.1%). O2 therapy lasted an average of 8.89 ± 4.57 days. Significantly more (p = 0.001) neonates with pneumothorax had additional complications, pneumonia, sepsis, convulsions and intraventricular hemorrhage (68.9%). However, most children had a good outcome (83.8%) and were discharged from the clinic. Fatal outcomes occurred in six cases, while another six neonates had to be transferred to referral neonatal centers for further treatment and care. Conclusion: Significantly more children with pneumothorax were born prematurely than at term. With adequate therapy, even premature newborns can successfully recover from pneumothorax.
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Affiliation(s)
- Miljana Z. Jovandaric
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- Correspondence:
| | - Svetlana J. Milenkovic
- Department of Neonatology, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Jelena Dotlic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana R. Babovic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia
| | - Zorica Jestrovic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
| | - Branislav Milosevic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
| | - Miljan Culjic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
| | - Sandra Babic
- Department of Gynecology and Obstretics, Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (J.D.); (I.R.B.); (Z.J.); (B.M.); (M.C.); (S.B.)
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Choi EK, Park KH, Choi BM. Association of delayed initiation of non-invasive respiratory support with pulmonary air leakage in outborn late-preterm and term neonates. Eur J Pediatr 2022; 181:1651-1660. [PMID: 35006375 DOI: 10.1007/s00431-021-04317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
UNLABELLED The frequency of non-invasive respiratory support use has increased in neonates of all gestational ages with respiratory distress (RD). However, the impact of delayed initiation of non-invasive respiratory support in outborn neonates remains poorly understood. This study aimed to identify the impact of the delayed initiation of non-invasive respiratory support in outborn, late-preterm, and term neonates. Medical records of 277 infants (gestational age of ≥ 35 weeks) who received non-invasive respiratory support as primary respiratory therapy < 24 h of age between 2016 and 2020 were retrospectively reviewed. Factors associated with respiratory adverse outcomes were investigated in 190 outborn neonates. Infants with RD were divided into two groups: mild (fraction of inspired oxygen [FiO2] ≤ 0.3) and moderate-to-severe RD (FiO2 > 0.3), depending on their initial oxygen requirements from non-invasive respiratory support. The median time for the initiation of non-invasive respiratory support at a tertiary center was 3.5 (2.2-5.0) h. Male sex, a high oxygen requirement (FiO2 > 0.3), high CO2 level, and respiratory distress syndrome were significant factors associated with adverse outcomes. Subgroup analysis revealed that in the moderate-to-severe RD group, delayed commencement of non-invasive respiratory support (≥ 3 h) was significantly associated with pulmonary air leakage (p = 0.033). CONCLUSION Our study shows that outborn neonates with moderate-to-severe RD, who were treated with delayed non-invasive respiratory support, were associated with an increased likelihood of pulmonary air leakage. Additional prospective studies are required to establish the optimal timing and methods of non-invasive respiratory support for outborn, late-preterm, and term infants. WHAT IS KNOWN • Non-invasive respiratory support is widely used in neonates of all gestational ages. • Little is known on the impact of delayed initiation of non-invasive respiratory support in outborn, late preterm, and term neonates. WHAT IS NEW • Male sex, high oxygen requirement (FiO2 >0.3), high initial CO2 level, and respiratory distress syndrome significantly correlated with adverse outcomes. • Outborn late-preterm and term neonates with high oxygen requirement who were treated with delayed non-invasive respiratory support indicated an increased likelihood of pulmonary air leakage.
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Affiliation(s)
- Eui Kyung Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hee Park
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Min Choi
- Department of Pediatrics, Korea University College of Medicine, Seoul, Republic of Korea.
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Bogdan RD, Bohiltea RE, Toma AI. Respiratory Follow Up of the Premature Neonates-Rationale and Practical Issues. J Clin Med 2022; 11:jcm11061746. [PMID: 35330070 PMCID: PMC8955296 DOI: 10.3390/jcm11061746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/13/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of the review was to present the state of knowledge about the respiratory pathology in former premature neonates (children that were born preterm-before 37 weeks of gestation-and are examined and evaluated after 40 weeks corrected age) other than chronic lung disease, in order to provide reasons for a respiratory follow-up program for this category of patients. After a search of the current evidence, we found that premature infants are prone to long-term respiratory consequences due to several reasons: development of the lung outside of the uterus, leading to dysmaturation of the structures, pulmonary pathology due to immaturity, infectious agents or mechanical ventilation and deficient control of breathing. The medium- to long-term respiratory consequences of being born before term are represented by an increased risk of respiratory infections (especially viral) during the first years of life, a risk of recurrent wheezing and asthma and a decrease in pulmonary volumes and airway flows. Late preterm infants have risks of pulmonary long-term consequences similar to other former premature infants. Due to all the above risks, premature neonates should be followed in an organized fashion, being examined at regular time intervals from discharge from the maternity hospital until adulthood-this could lead to an early detection of the risks and preventive therapies in order to improve their prognosis and assure a normal and productive life. The difficulties related to establishing such programs are represented by the insufficient standardization of the data gathering forms, clinical examinations and lung function tests, but it is our belief that if more premature infants are followed, the experience will allow standards to be established in these fields and the methods of data gathering and evaluation to be unified.
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Affiliation(s)
- Raluca Daniela Bogdan
- Pediatrics Department, Medicover Hospital, Str. Pechea No. 8, Sector 1, 031056 Bucharest, Romania;
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bd Eroii Sanitari Nr 8, 050471 Bucharest, Romania
- Correspondence: (R.E.B.); (A.I.T.); Tel.: +40-756-565670 or +40-723-188-272 (A.I.T.)
| | - Adrian Ioan Toma
- Neonatology Department, Life Memorial Hospital, Calea Grivitei No. 365, Sector 1, 010719 Bucharest, Romania
- Faculty of Medicine, University “Titu Maiorescu”, Str. Gh Petrascu 67, Sector 3, 031593 Bucharest, Romania
- Correspondence: (R.E.B.); (A.I.T.); Tel.: +40-756-565670 or +40-723-188-272 (A.I.T.)
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18
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Kim EA, Jung JH, Lee SY, Park SH, Kim JS. Neonatal Pneumothorax in Late Preterm and Full-Term Newborns with respiratory Distress: A Single-Center Experience. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: To evaluate the incidence rate, clinical characteristics, and perinatal outcomes of pneumothorax in late preterm and full-term newborns with respiratory distress and analyze the risk factors associated with pneumothorax.Methods: Infants born at ≥34 weeks’ gestation with respiratory distress and pneumothorax admitted between February 2014 and December 2020 were enrolled in this study. The pneumothorax group (n=36) was matched to the control group (n=144) in a 1:4 ratio, based on gestational age and birth weight. Risk factors were identified using logistic regression analysis with backward stepwise selection.Results: The incidence of pneumothorax during the study period was 1.36% (38/2,788). All patients were diagnosed with pneumothorax within 48 hours after birth, and increased oxygen demand was the most common symptom. The proportion of mortality and perinatal morbidity, such as intraventricular hemorrhage ≥grade 3, was significantly higher in the pneumothorax group than in the control group. The risk factors associated with pneumothorax were the need for positive pressure ventilation in the delivery room (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.26 to 9.12; P=0.015) and a higher fraction of inspired oxygen to achieve an oxygen saturation of ≥90% on admission (OR, 1.06; 95% CI, 1.03 to 1.09; P<0.001).Conclusion: Pneumothorax should be suspected in late preterm and full-term newborns with respiratory distress within the first 3 days of life. Based on these risk factors, early diagnosis can reduce perinatal mortality and morbidity.
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MELEKOĞLU N, SİNANOĞLU MS, BERK E. Evaluation of Pneumothorax in Neonatal Intensive Care Unit. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2022. [DOI: 10.17944/mkutfd.991806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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20
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Stocks EF, Jaleel M, Smithhart W, Burchfield PJ, Thomas A, Mangona KLM, Kapadia V, Wyckoff M, Kakkilaya V, Brenan S, Brown LS, Clark C, Nelson DB, Brion LP. Decreasing delivery room CPAP-associated pneumothorax at ≥35-week gestational age. J Perinatol 2022; 42:761-768. [PMID: 35173286 PMCID: PMC8853308 DOI: 10.1038/s41372-022-01334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We previously reported an increase in pneumothorax after implementing delivery room (DR) continuous positive airway pressure (CPAP) for labored breathing or persistent cyanosis in ≥35-week gestational age (GA) neonates unexposed to DR-positive pressure ventilation (DR-PPV). We hypothesized that pneumothorax would decrease after de-implementing DR-CPAP in those unexposed to DR-PPV or DR-O2 supplementation (DR-PPV/O2). STUDY DESIGN In a retrospective cohort excluding DR-PPV the primary outcome was DR-CPAP-related pneumothorax (1st chest radiogram, 1st day of life). In a subgroup treated by the resuscitation team and admitted to the NICU, the primary outcome was DR-CPAP-associated pneumothorax (1st radiogram, no prior PPV) without DR-PPV/O2. RESULTS In the full cohort, occurrence of DR-CPAP-related pneumothorax decreased after the intervention (11.0% vs 6.0%, P < 0.001). In the subgroup, occurrence of DR-CPAP-associated pneumothorax decreased after the intervention (1.4% vs. 0.06%, P < 0.001). CONCLUSION The occurrence of CPAP-associated pneumothorax decreased after avoiding DR-CPAP in ≥35-week GA neonates without DR-PPV/O2.
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Affiliation(s)
- Edward F. Stocks
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,grid.266900.b0000 0004 0447 0018Present Address: Oklahoma University, Norman, OK USA
| | - Mambarambath Jaleel
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - William Smithhart
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,Present Address: Newborn Associates, Jackson, MO USA
| | - Patti J. Burchfield
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Anita Thomas
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Kate Louise M. Mangona
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Vishal Kapadia
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Myra Wyckoff
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
| | | | - Shelby Brenan
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,Present Address: Pediatrix, Colorado Springs, CO USA
| | - L. Steven Brown
- grid.417169.c0000 0000 9359 6077Parkland Health & Hospital System, Dallas, TX USA
| | - Christopher Clark
- grid.417169.c0000 0000 9359 6077Parkland Health & Hospital System, Dallas, TX USA
| | - David B. Nelson
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA ,grid.417169.c0000 0000 9359 6077Parkland Health & Hospital System, Dallas, TX USA
| | - Luc P. Brion
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, TX USA
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Miyamoto M, Suzumura H, Yoshihara S. Retropharyngeal emphysema in a newborn with inspiratory stridor. Pediatr Int 2021; 63:1249-1250. [PMID: 34254720 DOI: 10.1111/ped.14584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/18/2020] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Manabu Miyamoto
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
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22
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Effect of continuous positive airway pressure versus nasal cannula on late preterm and term infants with transient tachypnea of the newborn. J Perinatol 2021; 41:1675-1680. [PMID: 33986469 DOI: 10.1038/s41372-021-01068-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare continuous positive airway pressure (CPAP) with nasal cannula (NC) as primary noninvasive respiratory therapy in hypoxic infants for transient tachypnea of the newborn (TTN). STUDY DESIGN Retrospective cohort study of infants born at ≥34 weeks of gestation between January 1, 2015 and December 31, 2018. RESULT After adjusting for gestational age and birth weight, the maximum fractional inspired oxygen (FiO2) was significantly lower in the CPAP group with an incidence rate ratio (IRR) of 0.85 (95% CI: 0.76-0.96). Although nonsignificant, the CPAP group needed 32% fewer hours on oxygen with an IRR of 0.68 (95% CI: 0.38-1.22). The duration of respiratory support and the incidence of pneumothorax were similar between both groups. CONCLUSION Comparing CPAP with NC as initial noninvasive respiratory therapy for TTN, significantly lower maximum FiO2 was observed in the infants of CPAP group without increase in the incidence of pneumothorax.
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Huseynov M, Hakalmaz AE. Neonatal pneumothorax from the perspective of a pediatric surgeon: classification and management protocol: a preliminary algorithm. Turk J Med Sci 2021; 51:1201-1210. [PMID: 33433972 PMCID: PMC8283476 DOI: 10.3906/sag-2010-286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/12/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Current neonatal pneumothorax classifications based on air volume escaping in pleural space have no contribution on the treatment. Therefore, our aim was to classify neonatal pneumothorax to guide treatment management based on our experiences. Material and methods The records of all neonates admitted to our clinics from March 2017 to August 2020 were reviewed. The patients with pneumothorax were identified through the neonatology department patient database search. The study only included the patients with symptomatic pneumothorax and these patients were evaluated into 3 groups based on the changes in peripheral oxygen saturation (SpO2) and clinical features immediately after the tube thoracostomy (TT) procedure. Accordingly, neonatal pneumothorax was divided into 3 types: patients with SpO2 increasing immediately after TT were included in type I, patients whose SpO2 did not change after TT were included in type II, and patients with SpO2 decreasing immediately after TT were included in type III pneumothorax. Results A total of 82 patients were included in the study. Sixty-one percent of these patients had type I, 24% had type II, and 15% had type III pneumothorax. None of the neonates died in type I and II pneumothoraces while 9 of 12 neonates (75%) died within the neonatal period in type III pneumothorax. Although we applied treatments such as high-frequency oscillatory ventilation, selective intubation, continuous negative aspiration, and surgical treatment to our patients that were lost due to type III pneumothorax, we were not successful. We successfully managed our surviving type III pneumothorax patients with a simple pressure cycle ventilator, using a combination of high rates, modest peak airway pressures [18 to 22 cm H2O and no positive end-expiratory pressure (PEEP)], and an autologous blood patch. Conclusion Classification of pneumothoraces into different types significantly contributes to patient treatment planning through a predetermined strategy, not through trial-and-error. High frequency and zero PEEP ventilation can provide significant improvement in risky cases.
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Affiliation(s)
- Mirzaman Huseynov
- Department of Pediatric Surgery, Private Safa Hospital, İstanbul, Turkey,Department of Pediatric Surgery, Private Avicenna Hospital, İstanbul, Turkey
| | - Ali Ekber Hakalmaz
- Department of Pediatric Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
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Merscher Alves MB, Conté N, Sory Diallo I, Roth-Kleiner M. Clinical presentation and improvised management of neonatal pneumothorax in the setting of a low-resource country: Conakry, Guinea. BMJ Case Rep 2021; 14:e235801. [PMID: 33753375 PMCID: PMC7986683 DOI: 10.1136/bcr-2020-235801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
Two neonates were presented at the Neonatology Department of the Institute of Child Nutrition and Health in Conakry, Guinea, with tension pneumothoraces as confirmed by chest X-ray. They were initially managed with needle thoracentesis but required continuous thoracic drainage. Due to scarce resources in the public health sector, no prepacked and dedicated pleural drainage systems were available as is the case in many developing countries. Therefore, we fabricated an improvised underwater seal drain out of a plastic infusion bottle and a Heimlich valve out of a vicryl fingerstall. Both devices have shown to be effective. Pneumothorax is a common and potentially life-threatening disease in neonates that often requires prompt treatment. This case series demonstrates how tension pneumothorax in two newborns was successfully managed by improvising different chest drainage systems. The depicted techniques shall serve as an instruction manual to healthcare professionals working in low-resource settings and facing similar challenges.
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Affiliation(s)
- Maria Bea Merscher Alves
- Pediatric and Neonatal Intensive Care Unit, Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N'fanly Conté
- Department of Neonatology, Institute of Nutrition and Child Health, Conakry, Guinea
| | - Ibrahima Sory Diallo
- Department of Neonatology, Institute of Nutrition and Child Health, Conakry, Guinea
- Department of Pediatrics, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Matthias Roth-Kleiner
- Clinic of Neonatology, Department Woman-Mother-Child, CHUV, Lausanne, VD, Switzerland
- Association souffle2vie, Epalinges, Switzerland
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Fei Q, Lin Y, Yuan TM. Lung Ultrasound, a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:359-369. [PMID: 33341304 DOI: 10.1016/j.ultrasmedbio.2020.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/24/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Neonatal pneumothorax is a life-threatening condition. Chest X-ray is the main diagnostic method but has some defects. Lung ultrasound has emerged as a diagnostic method in recent years. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against chest X-ray in neonates with pneumothorax. We searched the Chinese journal full-text database, Wanfang database, China biomedical document service system, Weipu Chinese science and technology periodical full-text database, EMBASE, PubMed, The Cochrane Library and Web of Science (up to January 2020) for prospective studies on the diagnostic accuracy of lung ultrasound in neonates with pneumothorax. Statistical analysis was undertaken using Meta-DiSc software, version 1.4 (Romany Cajal Hospital, Madrid, Spain). The search returned 528 studies, of which 8 full texts were assessed for eligibility against the inclusion/exclusion criteria. The overall specificity and sensitivity of lung ultrasound in the diagnosis of neonatal pneumothorax was 98% (95% confidence interval [CI]: 0.94-0.99) and 99% (95% CI: 0.98-1.00), respectively. The diagnostic odds ratio was 920.01 (95% CI: 265.81-3184.33), and the area under the curve was 0.996 7 (Q* = 0.978 5). However, the chest X-ray was always taken as the reference standard with a sensitivity of 82% (95% CI: 0.72-0.90), a specificity of 96% (95% CI: 0.90-0.99) and a diagnostic odds ratio of 44.54 (95% CI: 4.30-460.98). Study analysis studies indicated that the sensitivity of lung ultrasound in diagnosing pneumothorax excepted chest X-ray as the single diagnosis criteria was 98% (95% CI: 0.93-1.00), the specificity was 100% (95% CI: 0.96-1.00) and the diagnostic odds ratio was 965.39 (95% CI: 161.195781.93), showing a higher accuracy than chest X-ray. In conclusion, lung ultrasound had better sensitivity and specificity than chest X-ray in the diagnosis of pneumothorax. Some ultrasonic signs (absence of lung sliding or B-lines) had a high sensitivity in the diagnosis, which could be used to diagnose pneumothorax. Lung point could help judge the severity of pneumothorax. Its presence indicates that pneumothorax is mild to moderate; otherwise, pneumothorax is severe.
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Affiliation(s)
- Qiang Fei
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Yu Lin
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Tian-Ming Yuan
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Andersson J, Magnuson A, Ohlin A. Neonatal pneumothorax: symptoms, signs and timing of onset in the post-surfactant era. J Matern Fetal Neonatal Med 2021; 35:5438-5442. [PMID: 33535849 DOI: 10.1080/14767058.2021.1882981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM The primary objective was to describe the incidence, symptoms, clinical signs, and time of onset of neonatal pneumothorax in Örebro County during 2011-2017. Secondary objectives were to describe risk factors, diagnostic procedures, treatments, and mortality and to compare preterm with term/post-term neonates. MATERIALS AND METHODS This retrospective population-based descriptive study included all neonates born in Örebro County during 2011-2017 and admitted to the neonatal intensive care unit at Örebro University Hospital at age <28 days with an x-ray verified diagnosis of "Pneumothorax originating in the perinatal period" in their medical record. RESULTS Seventy-five neonates matched the inclusion criteria. The incidence of neonatal pneumothorax in Örebro County during the study period was 3.1 (95% CI: 2.5-3.8) per 1000 live births. All neonates were <48 h at debut of respiratory symptoms and the most common symptom was tachypnea. Twelve (16%) received invasive treatment. The mortality rate was 2 (3%), none due to pneumothorax. CONCLUSION The incidence of 3.1 per 1000 live births was relatively high, but the frequency of invasive treatment and mortality was low, indicating a high proportion of mild pneumothoraces. The lack of patients aged >48 h indicates that most neonatal pneumothoraces now occur very early in life.
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Affiliation(s)
| | - A Magnuson
- Clinical Epidemiology and Biostatistics Department, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - A Ohlin
- Department of Pediatrics, Örebro University Hospital, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Sandig J, Bührer C, Czernik C. [Lung Ultrasound in Neonatology to diagnose a Pneumothorax (part one): Evidence - Time for a New Standard Protocol]. Z Geburtshilfe Neonatol 2021; 225:15-18. [PMID: 33412598 DOI: 10.1055/a-1312-7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lung ultrasound is a well-studied diagnostic procedure in emergency medicine. Over the last several years, international research groups have investigated the role of lung ultrasound to evaluate neonatal respiratory diseases. Specific diagnostic algorithms and key features of a neonatal pneumothorax have been released. Compared to X-ray examination, lung ultrasound has many advantages, such as faster diagnostic time, lack of exposure to ionizing radiation, and excellent sensitivity and specificity. Thus, lung ultrasound contributes to the improvement of medical healthcare in the neonatal intensive care unit. We consider the use of lung ultrasound as a new standard procedure to diagnose a pneumothorax in neonatology.
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Affiliation(s)
- Jan Sandig
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin
| | - Christoph Bührer
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin
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Liu J, Qiu RX, Liu Y. Case Report: Neonatal Massive Pneumothorax Resulting in Compression Atelectasis Treated by Ultrasound-Guided Pleural Puncture Therapy: A Typical Case Based on Lung Ultrasound Finding. Front Pediatr 2021; 9:779615. [PMID: 34917564 PMCID: PMC8669828 DOI: 10.3389/fped.2021.779615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Atelectasis is a complication of different pulmonary diseases; however, neonatal compression atelectasis due to pneumothorax is rarely reported in the literature. Recently, we encountered a typical case of atelectasis. A preterm infant was admitted to the neonatal intensive care unit owing to severe respiratory distress. Lung ultrasound examination confirmed severe pneumothorax and large area of atelectasis. Lung re-expansion occurred when the air was drained from the pleural cavity.
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Abstract
OBJECTIVES To evaluate if "mirrored ribs"-a mirroring of chest structures-is a sign for pneumothorax in lung ultrasound in neonates. DESIGN Retrospective study. SETTING Medical University Vienna/General Hospital, Vienna, Austria. PATIENTS All neonates admitted with clinical signs of pneumothorax between July 2018 and February 2019. INTERVENTIONS Chest radiograph and lung ultrasound in succession. MEASUREMENTS AND MAIN RESULTS Anterior-posterior chest radiograph and lung ultrasound were compared. "Mirrored ribs" were defined as mirroring of at least one rib and intercostal muscles in B-mode in the absence of B-lines. Twenty-nine cases in 26 patients were considered. Pneumothorax was diagnosed in 55% of cases using reported signs for pneumothorax in lung ultrasound and in 31% using chest radiograph. Lung ultrasound identified all pneumothoraces visible in chest radiograph. "Mirrored ribs" were visible in all patients with signs for pneumothorax and in none without signs for pneumothorax in lung ultrasound, representing a specificity and sensitivity of 100% compared with reported signs for pneumothorax in lung ultrasound. CONCLUSIONS The occurrence of "mirrored ribs" in lung ultrasound in combination with absence of lung sliding, absence of B-lines and lung point might facilitate the rapid recognition of pneumothorax in neonates.
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Tan YL, Zhan Y, Geng J, Chen W, Guo WL. Predictors of chest drainage of pneumothorax in neonates. ACTA ACUST UNITED AC 2020; 53:e9469. [PMID: 32609260 PMCID: PMC7326378 DOI: 10.1590/1414-431x20209469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
This is a retrospective, single-center observational study to explore the predictors of chest drainage for neonatal pneumothorax. A total of 183 neonates (age ≤28 days) who presented to the Children's Hospital of Soochow University between January 1, 2015 and December 31, 2018 for pneumothorax or developed pneumothorax during a hospital stay were included. Demographic data, clinical presentation, and imaging characteristics of neonatal pneumothorax were collected and analyzed. We used univariate and multivariate logistic regression analyses to determine significant predictors of chest drainage of pneumothorax in neonates. Pneumothorax occurred within 24 h after birth in 131 (71.6%) cases, between 24 and 48 h after birth in 41 (22.4%) cases, and 48 h after birth in 11 (6.0%) cases. Univariate and multivariate logistic regression analyses revealed that lung collapse ≥1/3 on initial chest X-ray (OR 4.99, 95%CI 2.25-11.07), chest retractions (OR 8.12, 95%CI 2.88-22.89), cyanosis (OR 2.25, 95%CI 1.08-4.66), and frothing from mouth (OR 2.49, 95%CI 1.12-5.49) (P<0.05 for all) were significant predictors of the need for chest drainage due to pneumothorax. In conclusion, the thorough evaluation of the above predictive factors can guide treatment and improve patient outcome.
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Affiliation(s)
- Ya-Lan Tan
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, China
| | - Yang Zhan
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jia Geng
- Clinical Laboratory, 3rd Hospital of Yulin City, Yulin, China
| | - Wei Chen
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, China
| | - Wan-Liang Guo
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, China.,Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study. Pediatr Surg Int 2020; 36:669-677. [PMID: 32346849 DOI: 10.1007/s00383-020-04659-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE This study aimed to elucidate the clinical characteristics of neonates with congenital diaphragmatic hernia (CDH) associated with pneumothorax and evaluate the risk factors for the development of pneumothorax. METHODS A retrospective cohort study was conducted in the 15 institutions participating in the Japanese CDH Study Group. A total of 495 neonates with isolated CDH who were born between 2011 and 2018 were analyzed in this study. RESULTS Among the 495 neonates with isolated CDH, 52 (10.5%) developed pneumothorax. Eighteen (34.6%) patients developed pneumothorax before surgery, while 34 (65.4%) developed pneumothorax after surgery. The log-rank test showed that the cumulative survival rate was significantly lower in patients with pneumothorax than in those without pneumothorax. Univariate analysis revealed significant differences between patients with pneumothorax and those without pneumothorax with regard to the best oxygenation index within 24 h after birth, mean airway pressure (MAP) higher than 16 cmH2O, diaphragmatic defect size, and need for patch closure. Multiple logistic regression analysis indicated that only the MAP was associated with an increased risk of pneumothorax. CONCLUSIONS The cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients.
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Abstract
The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes, which are most obvious at the time of birth. Individuals who care for newly born infants must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement for any significant assistance. If newborns require assistance, the majority of the time respiratory support is all that is required. In some instances, however, there are circulatory emergencies that need to be rapidly identified or there may be dire consequences including death in the delivery room. This chapter will review various pathologies that are circulatory emergencies, and discuss how to assess them. We will also review new technologies which may help providers better understand the circulatory status or hemodynamic changes in the delivery room including heart rate, cardiac output, cerebral oxygenation and echocardiography.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.
| | - Wade D Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.
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Szymońska I, Wentrys Ł, Jagła M, Olszewska M, Wasilewska W, Smykla B, Kwinta P. Lung ultrasound reduces the number of chest X-rays in newborns with pneumothorax. DEVELOPMENTAL PERIOD MEDICINE 2019; 23. [PMID: 31654995 PMCID: PMC8522409 DOI: 10.34763/devperiodmed.20192303.172177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aim of the study: To determine the impact of lung ultrasonography as an imaging method used to diagnose and monitor newborns with symptomatic pneumothorax and to assess the risk factors for pneumothorax and the outcomes in newborns with symptomatic pneumothorax. PATIENTS AND METHODS Material and methods: A single-centre retrospective study enrolled patients born after 32 weeks of gestation, with a diagnosis of pneumothorax in the first week of life. The 118 patients who were included in the study were divided into two groups. Group A (51 infants) comprised those children who were treated between 2007 and 2010, while group B (n=67) those from the years 2013 to 2016. The children from group A were monitored with repeated chest X-rays. Those from group B received repeated lung ultrasonography supported by chest X-ray in those cases where there was diagnostic uncertainty. Comparison was made between the groups with respect to pneumothorax risk factors, treatment methods and the use of imaging during the period of treatment. The statistical analysis used χ2, Mann-Whitney and Student's t-tests. RESULTS Results: There were no significant demographic or clinical differences between the two groups. Both the use of nCPAP (nasal continuous positive airway pressure) (p<0.001) and diagnosed perinatal asphyxia (p=0.036) were higher in group B. Congenital pneumonia occurred more often in group A (p=0.041). Earlier detection of pneumothorax (p=0.001) and shorter hospital stay (p=0.03) were observed in group B. However, the total number of imaging (lung ultrasound and chest X-ray combined) was higher (p<0.001) in group B. CONCLUSION Conclusion: This study confirmed the usefulness of lung ultrasound in monitoring newborns with pneumothorax, moreover significantly limiting X-ray radiation.
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Affiliation(s)
- Izabela Szymońska
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland,Izabela SzymońskaDepartment of Pediatrics, Jagiellonian University Collegium Medicum, ul. Wielicka 265, 30-663 Kraków, Poland Mobile phone: +48 692-410-440 fax: (+48 12) 658-44-46
| | - Łukasz Wentrys
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Mateusz Jagła
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Marta Olszewska
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Weronika Wasilewska
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Barbara Smykla
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
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Smithhart W, Wyckoff MH, Kapadia V, Jaleel M, Kakkilaya V, Brown LS, Nelson DB, Brion LP. Delivery Room Continuous Positive Airway Pressure and Pneumothorax. Pediatrics 2019; 144:peds.2019-0756. [PMID: 31399490 DOI: 10.1542/peds.2019-0756] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In 2011, the Neonatal Resuscitation Program (NRP) added consideration of continuous positive airway pressure (CPAP) for spontaneously breathing infants with labored breathing or hypoxia in the delivery room (DR). The objective of this study was to determine if DR-CPAP is associated with symptomatic pneumothorax in infants 35 to 42 weeks' gestational age. METHODS We included (1) a retrospective birth cohort study of neonates born between 2001 and 2015 and (2) a nested cohort of those born between 2005 and 2015 who had a resuscitation call leading to admission to the NICU and did not receive positive-pressure ventilation. RESULTS In the birth cohort (n = 200 381), pneumothorax increased after implementation of the 2011 NRP from 0.4% to 0.6% (P < .05). In the nested cohort (n = 6913), DR-CPAP increased linearly over time (r = 0.71; P = .01). Administration of DR-CPAP was associated with pneumothorax (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 4.4-6.8); the OR was higher (P < .001) in infants receiving 21% oxygen (OR: 8.5; 95% CI: 5.9-12.3; P < .001) than in those receiving oxygen supplementation (OR: 3.5; 95% CI: 2.5-5.0; P < .001). Among those with DR-CPAP, pneumothorax increased with gestational age and decreased with oxygen administration. CONCLUSIONS The use of DR-CPAP is associated with increased odds of pneumothorax in late-preterm and term infants, especially in those who do not receive oxygen in the DR. These findings could be used to clarify NRP guidelines regarding DR-CPAP in late-preterm and term infants.
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Affiliation(s)
- William Smithhart
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
| | | | | | | | - David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, Texas; and
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics and
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Jaroensri S, Kamolvisit W, Nakwan N. Risk factor analysis of pneumothorax associated with persistent pulmonary hypertension of the newborn in Thai neonates. J Matern Fetal Neonatal Med 2019; 33:4090-4095. [PMID: 30880515 DOI: 10.1080/14767058.2019.1596403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To determine the risk factors and outcomes of persistent pulmonary hypertension of the newborn (PPHN)-associated pneumothorax (PTX).Study design: The medical records of infants diagnosed with PPHN with or without PTX from January 2012 to July 2017 were retrospectively reviewed.Results: Of the 102 included PPHN infants, PTX was found in 32 (31.4%) infants with 43.8% (14/32) mortality. PTX was significantly associated with increased mortality with an odds ratio (OR) of 5.27 (95% confidence interval [CI] 1.96-14.17). Unilateral PTX was more common than bilateral PTX (53.1 versus 46.9%, respectively). Multivariate logistic regression analysis indicated that a 1-minute Apgar score of ≤7 was associated with an increased risk for PTX (adjusted OR = 2.67 [95% CI 1.14-6.25]). In subgroup analysis, each increase of maximum peak inspiratory pressure (PIP) of 1 cmH2O significantly increased the odds of PTX by 1.46 (95% CI 1.02-2.07), while each 1 mmHg increase in arterial partial pressure of oxygen (PaO2) decreased the odds of PTX (adjusted OR = by 0.98 [95% CI 0.97-0.99]).Conclusions: PTX was significantly associated with higher mortality in PPHN infants. Lower Apgar score and increasing PIP in conventional mechanical ventilation were risk factors for PTX. Higher PaO2 was associated with a decreased rate of PTX.
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Affiliation(s)
- Sutthikiat Jaroensri
- Department of Pediatrics, Hat Yai Medical Education Center, Hat Yai Hospital, Hat Yai, Thailand
| | - Wuttichart Kamolvisit
- Department of Pediatrics, Hat Yai Medical Education Center, Hat Yai Hospital, Hat Yai, Thailand
| | - Narongsak Nakwan
- Department of Pediatrics, Hat Yai Medical Education Center, Hat Yai Hospital, Hat Yai, Thailand
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Hadzic D, Skokic F, Husaric E, Alihodzic H, Softic D, Kovacevic D. Risk Factors and Outcome of Neonatal Pneumothorax in Tuzla Canton. Mater Sociomed 2019; 31:66-70. [PMID: 31213960 PMCID: PMC6511380 DOI: 10.5455/msm.2019.31.66-70] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton. Methods: Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality. Results: During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax. Conclusion: All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement therapy and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.
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Affiliation(s)
- Devleta Hadzic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Fahrija Skokic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Edin Husaric
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Hajriz Alihodzic
- Emergency Department of Health Center Tuzla, Bosnia and Herzegovina
| | - Dzenana Softic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
| | - Dzenita Kovacevic
- Pediatric Clinic, University Clinical Center of Tuzla, Bosnia and Herzegovina
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37
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Pegu S, Bodani JP, Deb B. A case of significant subcutaneous emphysema on non-invasive respiratory support in a late preterm infant. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2017-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Air leaks are known complications associated with mechanical ventilation, with a higher incidence in more premature babies. Pneumothorax and pneumomediastinum are the most common ones and the majority would resolve spontaneously without active intervention. Subcutaneous emphysema is very rare, with few reported cases in neonates. We report here a case of extensive subcutaneous emphysema, pneumothorax and pneumomediastinum in a late preterm baby developed while on nasal continuous positive airway pressure (nCPAP) respiratory support.
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Affiliation(s)
- Satyaranjan Pegu
- Division of Neonatology, Department of Pediatrics , Regina General Hospital , 1440 14 Avenue , Regina, S4P 0W5, Saskatchewan , Canada , Tel: 306-766-0699, Fax 306-766-4149
| | - Jaya P. Bodani
- Division of Neonatology, Department of Pediatrics , Regina Qu’Appelle Health Region , Regina, SK , Canada
| | - Bakul Deb
- Division of Neonatology, Department of Pediatrics , Regina Qu’Appelle Health Region , Regina, SK , Canada
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38
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Liu J, Chi JH, Ren XL, Li J, Chen YJ, Lu ZL, Liu Y, Fu W, Xia RM. Lung ultrasonography to diagnose pneumothorax of the newborn. Am J Emerg Med 2017; 35:1298-1302. [PMID: 28404216 DOI: 10.1016/j.ajem.2017.04.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. METHODS This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. RESULTS (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. CONCLUSION Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China; Department of Neonatology and NICU of Bayi Children's Hospital, The Army General Hospital of the Chinese PLA, Beijing 100700, China.
| | - Jing-Han Chi
- Graduate School of Southern Medical University, Guangzhou City 510515, China; Department of Neonatology and NICU of Bayi Children's Hospital, The Army General Hospital of the Chinese PLA, Beijing 100700, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China; Department of Neonatology and NICU of Bayi Children's Hospital, The Army General Hospital of the Chinese PLA, Beijing 100700, China
| | - Jie Li
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China
| | - Ya-Juan Chen
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China; Department of Neonatology and NICU of Bayi Children's Hospital, The Army General Hospital of the Chinese PLA, Beijing 100700, China
| | - Zu-Lin Lu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China
| | - Ying Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China; Department of Neonatology and NICU of Bayi Children's Hospital, The Army General Hospital of the Chinese PLA, Beijing 100700, China
| | - Rong-Ming Xia
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing 100101, China
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39
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Oliveira B, Flôr-DE-Lima F, Rocha G, Rodrigues M, Ladeiras R, Guimarães H. The impact of intrauterine growth restriction on respiratory outcomes. Minerva Pediatr (Torino) 2017; 73:426-434. [PMID: 28565900 DOI: 10.23736/s2724-5276.17.04965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is caused by fetal growth below what is normal for its genetic potential. Recent studies have shown a distinct association between changes in umbilical artery flow in IUGR subjects and an increased risk of respiratory morbidity and consequently, higher mortality. The aim of this study was to find the impact of IUGR on the respiratory outcomes of premature neonates born with less than 32 weeks gestational age. METHODS This retrospective cohort study targeted infants born with less than 32 weeks of gestation, admitted at NCIU, between January 2010 and December 2016. Each selected IUGR case was matched according to gestational age and sex with an appropriate birthweight newborn at a 1:2 ratio, within a 12-month period. RESULTS The study involved 126 neonates, 42 with IUGR, and 84 control subjects. IUGR was not identified as a predictor of Bronchopulmonary Dysplasia (BDP) (OR 4.80, 95% CI: 1.14-20.21, P=0.033). Abnormal umbilical artery flow (OR 4.80, 95% CI: 1.14-20.21, P=0.033) and late onset sepsis (OR 3.31, 95% CI: 1.04-10.56, P=0.044) were significantly associated with BDP. CONCLUSIONS It is essential to recognize changes in the umbilical artery flow, especially in high-risk pregnancies such as IUGR, since these represent an a priori risk marker for the development of BDP. The individual and combined effect of IUGR, alterations on umbilical artery flow and extreme prematurity has not yet been completely clarified on the impact on lung morbidity, requiring a larger number of studies.
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Affiliation(s)
| | - Filipa Flôr-DE-Lima
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
| | - Gustavo Rocha
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
| | - Manuela Rodrigues
- Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
| | - Rita Ladeiras
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Faculty of Medicine, University of Porto, Porto, Portugal.,Neonatal Intensive Care Unit, Pediatric Hospital, Hospital of São João, Porto, Portugal
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40
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García-Muñoz Rodrigo F, Urquía Martí L, Galán Henríquez G, Rivero Rodríguez S, Tejera Carreño P, Molo Amorós S, Cabrera Vega P, Rodríguez Ramón F. Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants. J Matern Fetal Neonatal Med 2016; 30:2679-2685. [DOI: 10.1080/14767058.2016.1261281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - Lourdes Urquía Martí
- Hospital Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gloria Galán Henríquez
- Hospital Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sonia Rivero Rodríguez
- Hospital Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Silvia Molo Amorós
- Hospital Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Cabrera Vega
- Hospital Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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41
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Ismawan JM, Abdallah C. Retained surfactant catheter and pneumothorax in a premature neonate. J Neonatal Perinatal Med 2016; 9:321-3. [PMID: 27589543 DOI: 10.3233/npm-16915105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surfactant catheters are used to administer exogenous surfactant as a preventive and therapeutic measure for surfactant deficiency in premature neonates. We describe the case of a retained surfactant catheter in a 700 g premature neonate with associated pneumothorax.
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Affiliation(s)
- J M Ismawan
- Department of Anesthesiology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - C Abdallah
- Division of Anesthesiology, Sedation and Perioperative Medicine, Children's National, Washington, DC, USA
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42
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Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, Corsini I, Dani C, Grappone L, Orfeo L, Migliaro F, Vallone G, Capasso L. Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate. J Pediatr 2016; 175:74-78.e1. [PMID: 27189678 DOI: 10.1016/j.jpeds.2016.04.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/14/2016] [Accepted: 04/07/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient. STUDY DESIGN In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation <65% for more than 40 seconds) and bradycardia or sudden increase of oxygen requirement by at least 50% in less than 10 minutes with a final fraction of inspired oxygen ≥0.7 to keep stable saturations. All eligible patients had an ultrasound scan before undergoing a chest radiograph, which was the reference standard. RESULTS Forty-two infants (birth weight = 1531 ± 812 g; gestational age = 31 ± 3.5 weeks) were enrolled in 6 centers; pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases. CONCLUSIONS Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage.
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Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy.
| | | | | | | | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France
| | - Iuri Corsini
- Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy
| | - Carlo Dani
- Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy
| | - Lidia Grappone
- Division of Neonatology, Ospedale Rummo, Benevento, Italy
| | - Luigi Orfeo
- Division of Neonatology, Ospedale Rummo, Benevento, Italy
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Gianfranco Vallone
- Division of Pediatric Diagnostics, Department of Biomorphological and Functional Sciences, Università "Federico II," Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
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da Cunha Durães MI, Flor-De-Lima F, Rocha G, Soares H, Guimarães H. Morbidity and mortality of preterm infants less than 26 weeks of gestational age. Minerva Pediatr 2016; 71:12-20. [PMID: 27405904 DOI: 10.23736/s0026-4946.16.04609-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Extreme preterm infants have a high risk of morbidity and mortality. Newborns delivered between 23+0 and 25+6 weeks, are considered to be in the "gray zone" and have uncertain prognosis. For these children medical decision-making becomes complex and controversial. The present study intends to evaluate the neonatal morbidity and mortality of preterm infants born between 23 weeks and 25+6 weeks of gestational age. METHODS A retrospective study was conducted including all inborn preterm infants, with a gestational age between 23+0 and 25+6 weeks, admitted to a level IIIC NICU, between January 1st, 1996 and December 31st, 2014. RESULTS A total of 72 preterm neonates were included, 18.1% had a full cycle of antenatal steroids. The most frequent major morbidities were RDS (95.4%), patent ductus arteriosus (81.3%), sepsis (55.7%, being 19.7% early sepsis, and 36.1% late sepsis), intraventricular hemorrhage (34.4%), retinopathy of prematurity (21.9%) and necrotizing enterocolitis (10.9%). Fifty-four (75%) children died. The only factor adjusted to age associated with high mortality founded was hypotension (OR=4.99, P<0.019). Morbidity at discharge was: severe bronchopulmonary dysplasia (77.8%), retinopathy of prematurity (72.2%), intraventricular hemorrhage (16.7%), cystic periventricular leukomalacia (11.1%), and sequalae of necrotizing enterocolitis (5.6%). CONCLUSIONS The survival rate was 25% and a high morbidity at discharge was observed, which leave us with the huge responsibility to improve this result in a near future. Extreme prematurity is still a very controversial and complex issue and particular challenge for neonatologists. The use of antenatal steroid in the more immature preterm infants should be encouraged.
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Affiliation(s)
| | - Filipa Flor-De-Lima
- Department of Pediatrics, Faculty of Medicine, Porto University, Porto, Portugal.,Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal
| | - Gustavo Rocha
- Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal
| | - Henrique Soares
- Department of Pediatrics, Faculty of Medicine, Porto University, Porto, Portugal.,Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal
| | - Hercília Guimarães
- Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal
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44
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45
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Blank DA, Hooper SB, Binder-Heschl C, Kluckow M, Gill AW, LaRosa DA, Inocencio IM, Moxham A, Rodgers K, Zahra VA, Davis PG, Polglase GR. Lung ultrasound accurately detects pneumothorax in a preterm newborn lamb model. J Paediatr Child Health 2016; 52:643-8. [PMID: 27088264 DOI: 10.1111/jpc.13154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/23/2015] [Indexed: 11/26/2022]
Abstract
AIM Pneumothorax is a common emergency affecting extremely preterm. In adult studies, lung ultrasound has performed better than chest x-ray in the diagnosis of pneumothorax. The purpose of this study was to determine the efficacy of lung ultrasound (LUS) examination to detect pneumothorax using a preterm animal model. METHODS This was a prospective, observational study using newborn Border-Leicester lambs at gestational age = 126 days (equivalent to gestational age = 26 weeks in humans) receiving mechanical ventilation from birth to 2 h of life. At the conclusion of the experiment, LUS was performed, the lambs were then euthanised and a post-mortem exam was immediately performed. We used previously published ultrasound techniques to identify pneumothorax. Test characteristics of LUS to detect pneumothorax were calculated, using the post-mortem exam as the 'gold standard' test. RESULTS Nine lambs (18 lungs) were examined. Four lambs had a unilateral pneumothorax, all of which were identified by LUS with no false positives. CONCLUSIONS This was the first study to use post-mortem findings to test the efficacy of LUS to detect pneumothorax in a newborn animal model. Lung ultrasound accurately detected pneumothorax, verified by post-mortem exam, in premature, newborn lambs.
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Affiliation(s)
- Douglas A Blank
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Stuart B Hooper
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Corinna Binder-Heschl
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia.,Department of Neonatology, Medical University of Graz, Graz, Austria
| | - Martin Kluckow
- Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Andrew W Gill
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia
| | - Domenic A LaRosa
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Ishmael M Inocencio
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Alison Moxham
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Karyn Rodgers
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Valerie A Zahra
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Graeme R Polglase
- The Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
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46
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Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax. Can Respir J 2016; 2016:6515069. [PMID: 27445558 PMCID: PMC4904536 DOI: 10.1155/2016/6515069] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/17/2016] [Indexed: 01/31/2023] Open
Abstract
Background. Pneumothorax (PTX) still remains a common cause of morbidity in critically ill and ventilated neonates. At the present time, lung ultrasound (LUS) is not included in the diagnostic work-up of PTX in newborns despite of excellent evidence of reliability in adults. The aim of this study was to compare LUS, chest X-ray (CXR), and chest transillumination (CTR) for PTX diagnosis in a group of neonates in which the presence of air in the pleural space was confirmed. Methods. In a 36-month period, 49 neonates with respiratory distress were enrolled in the study. Twenty-three had PTX requiring aspiration or chest drainage (birth weight 2120 ± 1640 grams; gestational age = 36 ± 5 weeks), and 26 were suffering from respiratory distress without PTX (birth weight 2120 ± 1640 grams; gestational age = 34 ± 5 weeks). Both groups had done LUS, CTR, and CXR. Results. LUS was consistent with PTX in all 23 patients requiring chest aspiration. In this group, CXR did not detect PTX in one patient while CTR did not detect it in 3 patients. Sensitivity and specificity in diagnosing PTX were therefore 1 for LUS, 0.96 and 1 for CXR, and 0.87 and 0.96 for CTR. Conclusions. Our results confirm that also in newborns LUS is at least as accurate as CXR in the diagnosis of PTX while CTR has a lower accuracy.
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47
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Vanderbloemen L, Dorling D, Minton J. Visualising variation in mortality rates across the life course and by sex, USA and comparator states, 1933-2010. J Epidemiol Community Health 2016; 70:826-31. [PMID: 26933122 DOI: 10.1136/jech-2014-205226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/30/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Previous research showed that younger adult males in the USA have, since the 1950s, died at a faster rate than females of the same age. In this paper, we quantify this difference, and explore possible explanations for the differences at different ages and in different years. METHODS Using data from the Human Mortality Database (HMD), the number of additional male deaths per 10 000 female deaths was calculated for each year from 1933 to 2010, and for each year of age from 0 to 60 years, for the USA, and a number of other countries for comparison. The data were explored visually using shaded contour plots. RESULTS Gender differences in excess mortality have increased. Coming of age (between the ages of 15 and 25 years of age) is especially perilous for men relative to women now compared with the past in the USA; the visualisations highlight this change as important. CONCLUSIONS Sex differences in mortality risks at various ages are not static. While women may today have an advantage when it comes to life expectancy, in the USA, this has greatly increased since the 1930s. Just as young adulthood for women has been made safer through safer antenatal and childbirth practices, changes in public policy can make the social environment safer for men.
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Affiliation(s)
- Laura Vanderbloemen
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Danny Dorling
- School of Geography and the Environment, University of Oxford, Oxford, UK
| | - Jonathan Minton
- School of Social and Political Sciences, College of Social Sciences, University of Glasgow, Glasgow, UK
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48
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Pleural disease in infants and children: management updates. CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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49
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Abstract
KEY POINTS Respiratory distress is a common presenting feature among newborn infants.Prompt investigation to ascertain the underlying diagnosis and appropriate subsequent management is important to improve outcomes.Many of the underlying causes of respiratory distress in a newborn are unique to this age group.A chest radiograph is crucial to assist in diagnosis of an underlying cause. EDUCATIONAL AIMS To inform readers of the common respiratory problems encountered in neonatology and the evidence-based management of these conditions.To enable readers to develop a framework for diagnosis of an infant with respiratory distress. The first hours and days of life are of crucial importance for the newborn infant as the infant adapts to the extra-uterine environment. The newborn infant is vulnerable to a range of respiratory diseases, many unique to this period of early life as the developing fluid-filled fetal lungs adapt to the extrauterine environment. The clinical signs of respiratory distress are important to recognise and further investigate, to identify the underlying cause. The epidemiology, diagnostic features and management of common neonatal respiratory conditions are covered in this review article aimed at all healthcare professionals who come into contact with newborn infants.
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Affiliation(s)
| | | | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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50
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Arda MS, Hamrick MC, Kane TD. Conservative Treatment of Lung Perforation Secondary to Retained Catheter in an Extremely Low-Birth-Weight Premature Infant. European J Pediatr Surg Rep 2016; 3:68-70. [PMID: 26788450 PMCID: PMC4712057 DOI: 10.1055/s-0035-1552558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/30/2015] [Indexed: 11/24/2022] Open
Abstract
Airway injury may occur during the use of any instrumentation in premature infants. A surgical approach for the treatment of lung perforation in extremely low-birth-weight infants has been recommended in the past. Here, we present a case of lung perforation in an ex–28-week, 730-g premature infant, who sustained lung perforation, secondary to an 8-Fr suction catheter used to administer surfactant, in which the broken catheter was retained in the airway. Following removal of catheter by endoscopy, tension pneumothorax had occurred. Attempts were made to treat the patient with single chest tube, unfortunately as it was not efficacious, the second one was placed on the ipsilateral side of hemithorax and the patient recovered without further surgery.
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Affiliation(s)
- Mehmet Surhan Arda
- Department of Pediatric Surgery, Eskisehir Osmangazi University Medical School, Eskisehir, Turkey
| | - Miller C Hamrick
- Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia, United States
| | - Timothy D Kane
- Department of Pediatric Surgery, Children's National Medical Center, Washington, District of Columbia, United States
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