Management of pneumothorax in neonatal retrieval: a retrospective cohort study

Abstract

BackgroundManagement of pneumothorax in neonates requiring retrieval poses unique challenges, including decision to insert an intercostal catheter (ICC). We aimed to report the proportion and characteristics of neonates transported with and without ICC insertion and the incidence of deterioration in neonates transported with pneumothorax.MethodsA retrospective cohort study of neonates transported with pneumothorax between 2016 and 2020 in Victoria, Australia. Univariate analysis was performed on patient and clinical characteristics, followed by multivariate analysis to identify risks independently associated with ICC insertion.Results174 neonates were included. Mean (SD) gestational age (GA) was 37.5 (2.8) weeks. Eighty-two neonates (47%) had ICC inserted. On multivariate analysis, risk factors independently associated with ICC insertion were mechanical ventilation (MV) preceding retrieval team arrival (OR 12, 95% CI 3.1 to 46.6, p<0.001) and radiographical mediastinal shift (MS) (OR 6.2, 95% CI 2.4 to 16.2, p<0.001). Increasing GA is negatively associated with ICC insertion (OR 0.66, 95% CI 0.5 to 0.8, p<0.001). No significant difference in incidence of deterioration between the ICC group and the no-ICC group was observed (8.5% vs 5.4%, p=0.55). Ninety-five neonates were treated with needle aspiration (NA); 40 (42%) subsequently avoided ICC insertion. Twelve (13%) neonates transported without ICC had insertion within 24 hours following transport.ConclusionMany neonates with pneumothorax are transported without ICC, with low incidence of deterioration and ICC insertion within 24 hours after transport. More than a third of neonates managed with NA avoided ICC insertion. The likelihood of ICC insertion is increased by lower GA, MV prior to retrieval team arrival and radiographical MS.

Incidence and Management of Neonatal Pneumothorax in a 10-Hospital Regional Perinatal Network in Switzerland: A Retrospective Observational Study

“…In our study, NA had a significantly higher failure rate than CT drainage but interestingly, two of three of the patients were successfully treated with a single NA. These are better results compared with other studies, where the failure rate ranged from 70% in a retrospective study 29 and in a randomized study 11 to 89% in an observational study. 25 The open question, which lacks an answer for now, is the comparison of NA versus conservative treatment.…”

“…Our retrospective study analyzed a population of 173 patients with PTX, that is, to our knowledge, one of the largest sample sizes compared to the existing literature. 29 We found an incidence of 0.56 PTX per 100 live births compared with 0.05 to 2% in the literature. We found the same risk factors, such as male gender, resuscitation maneuvers at birth, and cesarean section.…”

“…Interestingly, Halibullah et al found similar results in a comparable population. 29 On the opposite, the absence of ventilation support or O 2 by mask was negatively associated with CT drainage. These findings may help determine the management of PTX in the future regarding the choice of treatment and give suggestions to develop new guidelines.…”

Differences in Possible Risk Factors, Treatment Strategies, and Outcomes of Neonatal Pneumothorax in Preterm and Term Infants

“…The CDI application rate for NP treatment was found significantly higher in infants below 34 weeks of gestation in the present study. Halibullah et al 24 reported that CDI was required in preterm infants in particular and that older newborns were treated with NA. In a meta-analysis that included 2 different studies, the first study found that 45% of newborns with a 31-week median GA and with NP treated with NA did not require CDI.…”