Newborn Pneumothorax - Understanding the Condition and Its Treatment

What Is Pneumothorax in Children?

The word “pneumo” indicates air, and “thorax” indicates the chest cavity. Pneumothorax is a condition where the air sacs or alveoli in the lungs are filled with excess air; these alveoli cannot hold the air anymore and slowly start leaking out of the lungs. This air accumulates in the spaces between the lungs and the ribcage. This is most commonly seen in preterm or premature babies. One common type of pneumothorax is respiratory distress syndrome seen in premature babies. The air trapped between the rib cage and the lungs causes excess pressure on the lungs and leads to lung collapse. In this condition, the air slowly leaks into the space between the lungs and ribcage. This happens mostly in the first 24 to 36 hours after birth. And the severity of the condition mostly depends on the site and the amount of leakage that occurs. Pneumothorax mostly occurs in newborn babies but can also be seen in other age groups. The incidence rate is about one to two percent in the normal population, and the incidence rate increases in infants with low birth weight, whose birthweight is less than 1500 grams.

What Are the Causes of Pneumothorax in Children?

The following are the causes of pneumothorax in children:

• Pneumothorax is most commonly seen in premature babies due to the poor development of the infant's lungs. The air is delivered to premature babies through ventilators (artificial breathing machines).

• The newborn babies lack surfactant, a viscous fluid that helps to inflate or open the lungs around the alveoli.

• Another frequently seen cause of pneumothorax in children is meconium aspiration (the early stool passed after birth, even before drinking first milk). This is due to the baby in the mother's womb breathing in meconium. Then the air gets trapped, and the lungs expand more than normal, leading to air leakage.

• The other causes may include lung infection and poor development of lung tissues.

What Are the Types of Pneumothorax?

There are two types of pneumothorax:

• Primary spontaneous pneumothorax.

• Secondary spontaneous pneumothorax.

1. Primary Spontaneous Pneumothorax: Very rarely, the leak may happen suddenly, which is called primary spontaneous pneumothorax. The cause for primary spontaneous pneumothorax is unknown, but healthy kids may also suffer from the condition. The exact reasons are unknown, but the studies state that the tear in the blebs and bullae of the lungs may cause primary spontaneous pneumothorax.

2. Secondary Spontaneous Pneumothorax: Secondary spontaneous pneumothorax is caused by any underlying lung conditions that may result in pneumothorax. The existing lung condition may weaken the lung tissue, resulting in a tear of the lining of the lungs and causing air leakage. The following are the lung conditions that cause secondary spontaneous pneumothorax in children:

• Asthma.

• Tuberculosis.

• Cystic fibrosis.

What Are Blebs and Bullae?

A bleb refers to a small collection of air that becomes trapped between the lung tissue and the inner lining of the chest wall (pleura). It appears as a small blister-like structure and is usually filled with air. Blebs are often caused by the rupture of tiny air sacs within the lung, known as alveoli. They are commonly associated with certain lung conditions, such as chronic obstructive pulmonary disease (COPD) and emphysema.

On the other hand, a bulla is a larger air-filled space that forms within the lung tissue itself. It is typically larger than a bleb and can range in size from a few centimeters to several centimeters in diameter. Bullae can occur when multiple adjacent alveoli coalesce, resulting in a single air-filled space. Like blebs, bullae are frequently seen in individuals with COPD or emphysema.

What Are the Symptoms of Pneumothorax in Children?

Symptoms may vary from child to child. Some healthy babies may not show any symptoms. But some may show the following symptoms:

• Rapid and deep breathing.

• Restlessness.

• Irritability.

• Noisy breathing.

• Nostril flaring.

• Excess strain on abdominal muscles.

• When the child breathes in, the skin over the chest sinks inside around the ribs.

• Color changes in the skin may turn pale or bluish in color.

What Are the Diagnostic Tests for Pneumothorax in Children?

First, the health care provider will ask for the symptoms and history of onset of the condition and do a general physical examination of the child. Then to rule out and confirm the diagnosis few laboratory tests will be recommended:

1. Chest X-Rays: Chest X-rays are used to determine the condition of the internal tissues, bone, and other adjacent organs. The X-rays may show abnormal air spaces in the image, collapsed lungs, and abnormal position of the internal organs.

2. Transillumination: The test involves inserting a fiber optic light in the baby's chest wall. Where there is air leakage, the fiber optic light gets brighter. This test is done only during emergency conditions.

What Are the Ways to Treat Pneumothorax in Children?

The treatment of pneumothorax depends on the severity, age, type of cause, symptoms, and overall health condition of the child. The treatment depends on how big and what symptoms it is causing. In a few cases where there are no symptoms, in such cases, the condition recovers on its own, but in a few conditions where there are symptoms, treatment is required.

The symptoms of air leakage are treated by:

• Providing extra oxygen may heal the condition faster, and the air leakage will be treated quickly.

• The air trapped between the lungs and the chest wall has to be removed. The doctor may insert a syringe or thin tube into the air space and then remove the air.

What Are the Complications of Pneumothorax in Children?

Pneumothorax in children has a few complications, such as death and cardiac arrest. The complications are caused by the air trapped in the space pushing or compressing the lungs and heart, causing lung and heart collapse.

Conclusion

Pneumothorax in children is a condition where the air gets trapped in between the space of the lungs and the chest cavity, causing pressure on the lungs and resulting in the burst of alveoli that leaks air into the spaces that compress the lungs and heart, causing few symptoms like rapid noisy breathing, fatigue, and restlessness. The condition has severe complications like cardiac arrest and death of the child, so it is very essential to be diagnosed and treated well to prevent major complications.