Significance of small anteromedial or subpulmonic pneumothoraces on admission chest radiographs in late preterm/term neonates

Abstract

Purpose: To determine whether subtle anteromedial or subpulmonic pneumothorax (PTX) on neonatal admission chest radiograph is associated with depressed Apgar scores and significant resuscitation. Methods: Retrospective review of 375 neonates admitted to the Neonatal Intensive Care Unit from 2010-2014 with respiratory distress born at 34 -42 weeks gestation. All patients received anteriorposterior supine chest radiographs within 48 hours of birth. Records were reviewed for details on patient demographics, route of delivery, and Apgar scores at 1 and 5 min. Image interpretations were performed by radiologists and neonatologists blinded to patient clinical details and radiology reports. Significant resuscitative patterns were coded as early or late. Fisher's exact test and odds ratios were used to determine the significance. Results: 14/375 (4%) were reported positive for PTX by both radiologist and neonatologist groups. Among these 14, 11 (79%) had early resuscitation with positive pressure ventilation and/or continuous positive airway pressure within 5 min of birth, which was significant compared to the neonates without PTX (p = 0.026). The median one minute Apgar for neonates with PTX was lower (5.0) than those without PTX (8.0). No neonate with these chest radiograph findings developed a tension PTX. Conclusion: The presence of small anteromedial or subpulmonic PTX is associated with a difficult transition to extra-uterine life which is correlated with low Apgar scores at one minute. Reporting these PTX is important due to its relation to early resuscitation. These radiograph findings may warrant closer monitoring and a higher intensity of care.