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Pneumothorax in the Newborn

(Collapsed Lung)

By

Arcangela Lattari Balest

, MD, University of Pittsburgh, School of Medicine

Last full review/revision Jul 2021| Content last modified Jul 2021
CLICK HERE FOR THE PROFESSONAL VERSION

Pneumothorax is a collection of air between the lung and the chest wall that develops when air leaks out of the lung.

  • This disorder may develop in newborns who have lung disorders such as respiratory distress syndrome or meconium aspiration syndrome, who are treated with continuous positive airway pressure (CPAP), or who are using a ventilator.

  • The lung may collapse, breathing may be difficult, and blood pressure may decrease.

  • The diagnosis is based on presence of breathing trouble, the results of a chest x-ray, and usually on the amount of oxygen and carbon dioxide in the newborn's blood.

  • Newborns who have trouble breathing are given oxygen, and air sometimes is removed from the chest cavity using a needle and syringe or a plastic drainage tube that is left in place.

Infrequently, it occurs as a complication resulting from the use of continuous positive airway pressure Obstructive sleep apnea Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and often temporarily decrease the amount of oxygen and increase the amount of carbon dioxide... read more Obstructive sleep apnea (CPAP—a technique that allows newborns to breathe on their own while receiving slightly pressurized air or oxygen) or a ventilator Mechanical Ventilation Mechanical ventilation is use of a machine to aid the movement of air into and out of the lungs. Some people with respiratory failure need a mechanical ventilator (a machine that helps air get... read more (a machine that helps air get in and out of the lungs). A pneumothorax can result in collapse of the lung and difficulty breathing. If enough air accumulates in the space between the lung and the chest wall, the veins that bring blood to the heart can be compressed. As a result, less blood fills the chambers of the heart, the output of the heart decreases, and the newborn’s blood pressure decreases.

Pneumothorax can occasionally happen spontaneously in newborns who do not have underlying lung disorders or who do not need breathing support. Some newborns who have a pneumothorax develop another lung disorder called persistent pulmonary hypertension Persistent Pulmonary Hypertension of the Newborn Persistent pulmonary hypertension of the newborn is a serious disorder in which the arteries to the lungs remain narrowed (constricted) after delivery, thus limiting the amount of blood flow... read more .

Other air-leak syndromes

Air can leak out of the lungs and into other tissues. These disorders are called air-leak syndromes.

Air that leaks from the lungs into the tissues in the center of the chest is called pneumomediastinum Pneumomediastinum Pneumomediastinum is air in the cavity in the central part of the chest (mediastinum). Air can enter the mediastinum when The small air sacs of the lungs (alveoli) become stretched and torn... read more . Unlike pneumothorax, this condition usually does not affect breathing and does not require treatment.

Other air-leak syndromes include pulmonary interstitial emphysema (air in the tissues of the lungs between the air sacs), pneumopericardium (air in the sac around the heart), and, rarely, pneumoperitoneum (air in the abdominal cavity) and subcutaneous emphysema (air under the skin).

Symptoms of Pneumothorax in the Newborn

Pneumothorax in the newborn sometimes causes no symptoms. However, it can be the cause of a newborn’s rapid breathing. Newborns also may grunt when breathing out and may have a bluish color to their skin and/or lips (cyanosis Cyanosis Cyanosis is a bluish discoloration of the skin resulting from an inadequate amount of oxygen in the blood. Cyanosis occurs when oxygen-depleted (deoxygenated) blood, which is bluish rather than... read more ). The chest on the affected side is sometimes more prominent than the unaffected side.

Diagnosis of Pneumothorax in the Newborn

  • Positive transillumination

  • Chest x-ray

Because many newborns have no symptoms, pneumothorax is suspected when newborns who have underlying lung disorders or newborns who are receiving CPAP or are on a ventilator develop worsening trouble breathing (respiratory distress), a drop in blood pressure, or both. When examining these newborns, doctors may notice diminished sounds of air entering and leaving the lung on the side of the pneumothorax.

In premature newborns, doctors sometimes shine a fiber-optic light through the affected side of the newborn’s chest while in a darkened room (transillumination). This procedure is done to show free air in the area surrounding the lungs (pleural cavity). A chest x-ray confirms the diagnosis of pneumothorax in the newborn.

Treatment of Pneumothorax in the Newborn

  • Oxygen

  • Sometimes removal of air from the chest cavity

No treatment is needed for newborns who do not have symptoms.

Full-term newborns who have mild symptoms may be placed in a small tent into which oxygen is pumped (an oxygen hood) or receive oxygen via a two-pronged tube placed in the nostrils so that they breathe air that contains more oxygen than the air in the room does. The amount of oxygen given is typically enough to maintain adequate oxygen levels in the blood. However, if the newborn’s breathing is labored or if the level of oxygen in the blood declines, and particularly if the circulation of blood is impaired, the air must be rapidly removed from the chest cavity. Air is removed from the chest cavity by using a needle and syringe. For newborns who are having serious respiratory distress, who are receiving CPAP, or who are on a ventilator, doctors may need to place a plastic tube into the chest cavity to continuously suction and remove air from the chest cavity. The tube can usually be removed after several days.

A pneumomediastinum can be seen on an x-ray and requires no treatment.

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Frequent doctor visits are recommended for all infants younger than 1 year of age. These visits, also called well-child visits, make it possible to check development, look for health problems, provide age-appropriate vaccinations, and educate parents. Which of the following is a condition that might affect some infants born very prematurely, with less than 32 weeks of development in the uterus?
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