Pneumothorax prevalence and mortality per gestational age in the newborn

Abstract

Objectives: Pneumothorax (PTX) in newborns is a life-threatening condition associated with high morbidity and mortality especially in premature infants. The frequency of PTX in neonates at different gestational ages (GA) and its impact on neonatal mortality have not been quantified. We aimed to determine: (1) the prevalence of PTX in neonates at different GA from ≤24 to ≥37 weeks, (2) the impact of PTX on mortality per GA, and (3) the impact of PTX on the length of stay (LOS) per GA.Methods: The national Kids' Inpatient Database for the years of 2006-2012 were used. We included all infants admitted to the hospital with a documented GA and International Classification of Disease 9 code of PTX. Bivariate and multivariate analyses were conducted and odds ratios (OR) were calculated.Results: A total of 10,625,036 infants were included; of them 3665 infants (0.034%) had a diagnosis of PTX, with highest prevalence at ≤24 weeks GA (0.67%), and lowest at term (0.02%). The overall mortality rate of patients with PTX was 8.8%, and greater in preterm (16.3%) versus term infants (2.7%). The association of mortality with PTX was greatest at GA of 29-32 weeks (OR = 8.55; 95% confidence interval: 6.56-11.13). Infants who survived until discharge had a median of 2-12 days longer LOS depending on GA category.

Risk factors and neonatal outcomes of pulmonary air leak syndrome in extremely preterm infants: A nationwide descriptive cohort study

“…On the other hand, the effect of sALS on mortality was not significant at 27 weeks of gestation, which seems to be due to the low mortality rate at 27 weeks of GA in both groups. In the large cohort study mentioned above, [29] it was reported that the effect of pneumothorax on death increased until GA reached a peak at 29 to 32 weeks, which was later than the peak of our study, and decrease. This pattern was similar with our study, although the range of GA was wide and the GA groups were divided roughly into it, and the mortality rates of the infants born before 29 weeks were lower than our study.…”

“…A previous study on preterm infants born at < 29 weeks GA showed similar results in terms of mortality rate due to pneumothorax. [ 7 ] A large cohort study using the National Kids Inpatient Database [ 29 ] reported that the mortality rate of infants born at ≥ 25 weeks GA was higher in infants with pneumothorax than in those without pneumothorax. However, infants born at < 25 weeks GA had lower mortality rates with pneumothorax than those without pneumothorax, and the authors explained this result with the possibility that the infant died before pneumothorax occurred.…”

Incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates

“…This finding contrasts significantly with the data on the incidence of pneumothorax usually described in the literature to date. 1,4 Recently, Acun et al 5 reported a global prevalence of pneumothorax in newborns of 0.034%, but the range of incidences described is broad depending on the population and the methodology used. In preterm newborns, the incidence of pneumothorax can reach 9%-20%.…”

“…Pneumothorax can develop spontaneously in healthy newborns or as a complication of a respiratory disease, neonatal respiratory distress syndrome, or meconium aspiration syndrome, among others. A wide range of incidence rates of pneumothorax in term newborns have been described, with that range between 0.05% and 0.17% 1–5 . However, these estimates are limited only to symptomatic newborns admitted to the neonatal intensive care unit (NICU) and having a chest X‐ray diagnosis.…”

“…The diagnosis of pneumothorax in neonates has traditionally been based on chest transillumination and chest X‐ray imaging. Studies that analyze the incidence of pneumothorax base the diagnosis on chest X‐ray findings, 3,5 mainly in symptomatic patients, so the true incidence of asymptomatic air leaks is unknown. The objective of this study was to determine the true incidence of ultrasonographic signs consistent with pneumothorax in asymptomatic neonates using pulmonary ultrasound as a diagnostic tool.…”