Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study

Abstract

BackgroundLittle evidence exists regarding the optimal concentration of oxygen to use in the treatment of term neonates with spontaneous pneumothorax (SP). The practice of using high oxygen concentrations to promote “nitrogen washout” still exists at many centers. The aim of this study was to identify the time to clinical resolution of SP in term neonates treated with high oxygen concentrations (HO: FiO2 ≥ 60%), moderate oxygen concentrations (MO: FiO2 < 60%) or room air (RA: FiO2 = 21%).MethodsA population based cohort study that included all term neonates with radiologically confirmed spontaneous pneumothorax admitted to all neonatal intensive care units in Calgary, Alberta, Canada, within 72 hours of birth between 2006 and 2010. Newborns with congenital and chromosomal anomalies, meconium aspiration, respiratory distress syndrome, and transient tachypnea of newborn, pneumonia, tension pneumothorax requiring thoracocentesis or chest tube drainage or mechanical ventilation before the diagnosis of pneumothorax were excluded. The primary outcome was time to clinical resolution (hours) of SP. A Cox proportional hazards model was developed to assess differences in time to resolution of SP between treatment groups.ResultsNeonates were classified into three groups based on the treatment received: HO (n = 27), MO (n = 35) and RA (n = 30). There was no significant difference in time to resolution of SP between the three groups, median (range 25th-75th percentile) for HO = 12 hr (8–27), MO = 12 hr (5–24) and RA = 11 hr (4–24) (p = 0.50). A significant difference in time to resolution of SP was also not observed after adjusting for inhaled oxygen concentration [MO (a HR = 1.13, 95% CI 0.54-2.37); RA (a HR = 1.19, 95% CI 0.69-2.05)], gender (a HR = 0.87, 95% CI 0.53-1.43) and ACoRN respiratory score (a HR = 0.7, 95% CI 0.41-1.34).ConclusionsSupplemental oxygen use or nitrogen washout was not associated with faster resolution of SP. Infants treated with room air remained stable and did not require supplemental oxygen at any point of their admission.

A newborn infant with respiratory distress: More than meets the eye

“…Approximately 1-2% of term and 5-7% of preterm infants have evidence of a spontaneous pneumothorax on chest X-ray, although few are clinically significant. 4 If the pneumothorax is thought to be contributing to significant respiratory distress or is haemodynamically significant, thoracentesis and chest tube placement may be beneficial. 3 Risk factors for neonatal air leak include: prematurity, meconium aspiration syndrome, c-section, pulmonary hypoplasia and mechanical ventilation (particularly with excessive, prolonged or high inspiratory pressures).…”

Management of pneumothorax with oxygen therapy: a case series

“…15 In a few studies in the pediatric population, supplemental oygen use was not associated with a faster resolution of spontaneous pneumothorax. 18,19 Occasionally we may encounter asymptomatic patients with pneumothorax of large size refusing placement of ICT and surgery. These patients cannot be sent home without treatment.…”

Does oxygen therapy increase the resolution rate of primary spontaneous pneumothorax?

“…In addition, some animal studies have shown that increasing the fraction of inspired oxygen accelerates the resolution rate (4,11). However, recent neonatal studies reported no association between oxygen therapy and resolution rate (7,8).…”

“…There is a lack of clinical evidence for the effectiveness of oxygen therapy for primary spontaneous pneumothorax (PSP), which usually occurs in young adults or adolescents. Recent studies reported no association between oxygen therapy and the resolution rate of neonatal pneumothorax (7,8). We conducted a retrospective study to evaluate the effect of oxygen therapy on the resolution rate of PSP.…”