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Pneumothorax

What is pneumothorax?

Pneumothorax is a condition in which air in the lungs leaks into the chest cavity. Pneumothorax is one type of a group of lung disorders called air leak syndrome. A baby can have more than one form of air leak. Other types of air leaks include the following:

  • Pneumomediastinum. Air leaks into the mediastinum. This is the space in the thoracic cavity behind the sternum and between the two pleural sacs containing the lungs.

  • Pneumopericardium. Air leaks into the sac surrounding the heart.

  • Pulmonary interstitial emphysema (PIE). Air leaks out of the alveoli, the tiny air sacs of the lungs.

Air leaks may come on suddenly or may develop slowly. The degree of illness depends on the location of the leak, how quickly the leak occurs, and the amount of air.

What causes pneumothorax?

The pressure of the air delivered by breathing machines (mechanical ventilators) is the most common cause. Inhalation of the first stools passed while the baby is still in the mother’s uterus (meconium aspiration) can also trap air. This can lead to the lungs expanding too much and to air leaks. Air leaks often occur in the first 24 to 36 hours after birth. Some otherwise healthy babies can develop a spontaneous air leak that does not cause symptoms or distress.

Who is affected by pneumothorax and air leak syndrome?

Babies most at risk for pneumothorax are:

  • Babies with other lung diseases such as respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD)

  • Babies on mechanical ventilators

  • Premature babies whose lung tissues are more fragile

  • Babies with meconium aspiration, because the meconium plugs the airways, causing areas of the lungs to collapse

What are the symptoms of pneumothorax and other air leaks?

The following are the most common signs and symptoms of pneumothorax. However, each baby may experience symptoms differently. Symptoms may include:

  • Increasing respiratory distress, including rapid breathing, grunting, nostril flaring, and chest wall retractions

  • Trouble hearing or abnormal breath sounds when listening with a stethoscope

  • Changes in arterial blood gas levels

The signs and symptoms of pneumothorax may resemble other conditions or health problems. Always consult your baby's healthcare provider for a diagnosis.

How are pneumothorax and other air leaks diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for pneumothorax may include:

  • Chest X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. X-rays may show the following:

    • Air in places that is not normal

    • Collapse of the lung

    • Abnormal position of structures in the chest

  • Transillumination. A fiber optic light probe placed on the baby's chest wall (the side of the chest with the air leak transmits brighter light). This procedure is often used in an emergency.

  • Ultrasound. Sound waves are used to determine if the lung surface is touching the inner chest wall.

Treatment for pneumothorax and other air leaks

Your baby’s healthcare provider will figure out the best treatment plan for your baby based on:

  • Your baby's gestational age, overall health, and medical history

  • How sick your baby is

  • How well your baby handles certain medicines, treatments, or therapies

  • If your baby’s condition is expected to get worse

  • The opinion of the healthcare providers involved in your child's care

  • Your opinion or preference

Treatment for pneumothorax may include:

  • Supplemental oxygen

  • Removal of the collected air through insertion of a chest tube. This may be a needle or a thin tube (catheter) placed through the chest wall into the air space). The air may be removed with a syringe. Or the tube may be connected to a drainage system to help remove the air until the leak can seal.

Spontaneous air leaks that do not cause symptoms or distress may get better on their own without treatment. As the leak seals over, air is absorbed into the body.

There are no specific treatments for pneumomediastinum and pulmonary interstitial emphysema (PIE). That’s because these air leaks are in spaces that can’t be treated with chest tubes. High frequency ventilation, a special kind of mechanical ventilation, is sometimes used for babies with PIE.

Prevention of pneumothorax and other air leaks

Despite careful regulation of the air pressure and the settings on mechanical ventilators, air leaks can still occur. Your baby's healthcare provider and other providers in the newborn intensive care unit (NICU) will watch your baby carefully for signs of air leak so that treatment can be started as quickly as possible.