What Is Pneumothorax?
Pneumothorax is a condition caused by penetrating or blunt injuries that lead to leakage of air in the space between the lungs and the ribs. A classic sign of pneumothorax is shortness of breath, bluish discoloration of the skin, dry cough, and sharp stabbing chest pain that worsens on the effort to breathe. The severity of the condition is based on the amount of air that accumulates in the pleural space.
What Is Neonatal Pneumothorax?
Neonatal pneumothorax is also a condition where the air leaks and accumulates in the cavity between the chest wall and the lungs (pleural spaces), as this condition is seen in newborns within 24 to 36 hours of birth hence named neonatal pneumothorax. The condition is caused when tiny air sacs or the alveoli in the lungs get over-inflated and rupture. The severity of the disease is determined by the amount of air leak, the site of the leakage, and the frequency with which air escapes the alveoli. Neonatal pneumothorax can occur all of a sudden or might develop slowly.
What Are the Causes of Neonatal Pneumothorax?
There are various reasons or conditions that lead to the occurrence of neonatal pneumothorax. Some of the most common causes include:
Respiratory Distress Syndrome: A condition that is commonly encountered in premature births. Patients with respiratory distress syndrome lack a substance called surfactant, which helps in inflating the lungs and keeping them open. As a child lacks surfactant, it becomes difficult for a child to breathe as the alveolar sacks which are the tiny but functional units of the lungs are unable to expand. Therefore, such children require mechanical ventilation.
Meconium Aspiration Syndrome: A condition caused as the child aspirates the first bowel movement during intrauterine life, this meconium can obstruct the airway and result in difficulty in breathing.
Pneumonia: Neonatal pneumonia is the infection of the newborn caused by bacteria during the birth or post-birth in the NICU (neonatal intensive care unit) or from the hospital environment. This encounters six to eight percent of neonatal deaths. The common symptoms that help in diagnosis include wheezing, cough, fever, and restlessness.
Underdeveloped Lung Tissue: This is most commonly seen in children with premature birth and is known by various names such as headline membrane disease, surfactant deficiency lung disease, etc. Children with underdeveloped lung tissue face difficulties in breathing and suffer mainly due to oxygen deficiency.
What Are the Signs and Symptoms of Neonatal Pneumothorax?
Many newborns with pneumothorax are asymptomatic. When symptoms do emerge, they may include the following:
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Bluish discoloration of the skin (cyanosis).
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Increased rate of breathing.
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Flared nostrils.
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Grunting with breathing.
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Irritations.
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Restlessness and discomfort.
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Use of additional muscles to help in breathing which includes muscles of the chest and abdomen (retractions).
How Is Neonatal Pneumothorax Diagnosed?
When hearing the infant's lungs using a stethoscope, the healthcare provider might observe difficulties hearing breath sounds. The heart or breathing sounds may appear to come from a different place of the chest than usual.
Pneumothorax tests include:
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With a light probe placed against the chest, the areas with air accumulation appear radiolucent and therefore the imaging is also called transillumination.
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Computed tomography.
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Chest X-ray.
How Is Pneumothorax Prevented?
There is no known way to prevent pneumothorax, but cesarian section, and the use of pulmonary surfactant, are some of the ways to avoid neonatal pneumothorax as the condition is closely related to wet lungs and mechanical ventilation.
How Is Neonatal Pneumothorax Treated?
The treatment in patients with pneumothorax is required only when the subject is symptomatic. The steps in management include:
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Observation: Small pneumothoraces without symptoms may be managed by close observation to monitor for any changes or worsening of the condition. In many cases, the air in the pleural space is reabsorbed naturally by the body.
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Needle Aspiration: If the pneumothorax is larger or causing respiratory distress, a healthcare provider may perform needle aspiration to remove the air from the pleural space. Needle aspiration consists of inserting a needle into the chest to release the trapped air. Sometimes, a chest tube may be inserted for continuous drainage.
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Chest Tube Insertion: In cases where the pneumothorax is persistent or recurrent, a chest tube may be inserted to help evacuate the air and re-expand the affected lung. Typically, the chest tube is attached to a drainage system to collect the air and fluid.
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Mechanical Ventilation: In severe cases or if the baby is experiencing respiratory distress, mechanical ventilation may be necessary. This involves using a machine to support the baby's breathing until the pneumothorax resolves and the lungs recover.
What Are the Complications of Neonatal Pneumothorax?
Complications can arise from neonatal pneumothorax, such as tension pneumothorax or associated lung damage. Tension pneumothorax is a condition that occurs as a complication of pneumothorax and is considered a medical emergency as tension developed in the chest cavity builds pressure over the heart and the lungs and can collapse the organs, which can cause life-threatening complications.
What Is the Prognosis of Neonatal Pneumothorax?
The prognosis of neonatal pneumothorax depends on several factors, including the severity of the condition, the root cause, and the speed and efficacy of treatment.
In general, if diagnosed and treated promptly, the prognosis for neonatal pneumothorax is favorable. Many cases resolve on their own without any intervention, especially if the pneumothorax is small. However, larger or more severe pneumothoraces may require treatment to prevent complications and ensure the baby's well-being.
Conclusion:
Neonatal pneumothorax is a condition caused due to leakage of air in the pleural space. This condition when occurs during birth or during a week after birth is termed neonatal pneumothorax. Many cases, particularly small pneumothoraces, resolve on their own without intervention. However, larger or more severe pneumothoraces may require treatment to prevent complications and ensure the well-being of the newborn. Neonatal pneumothorax is caused by various conditions like respiratory distress syndrome and can be life-threatening. The condition is diagnosed with the help of a chest X-ray and can be treated, but there are no known preventive measures.
