Spontaneous Pneumothorax in the Newborn

Abstract

The case of spontaneous pneumothorax reported here is presented not only because of the rarity of the condition but because it is the only instance that I have been able to find in which roentgen evidence of the mechanism has been available.When one reviews the literature it soon becomes evident that there is a tremendous amount of confusion as to the limitations that should be applied to the descriptive term spontaneous pneumothorax in the newborn. It would seem that the term could be better applied if it were not extended so as to include the entire neonatal period, ordinarily reckoned at about one month, but were limited to the period between birth and the establishment of the normal vital processes. This period then would be limited to the first four or five days of life, and lesions that made their first appearance after this time might better be considered as disturbances having a separate cause.The reason for this differentiation is that there is a group of symptom complexes that arise at the onset of respiration and are characteristically different from disturbances arising at a later date. In this group are congenital deformity, congenital atelectasis and mechanical interference with respiration.The group which consists of the cases of congenital malformation of the respiratory tract, of course, requires separate treatment. Atelec¬ tasis may be due either to mechanical interference with respiration or to intrinsic factors which prevent proper aeration of the lung. Mechanical interference with respiration may give rise either to atelectasis or, occa¬ sionally, to emphysema, followed by rupture of the lung and pneumo¬ thorax. The term spontaneous also has particular significance in this group because the lesion, as it occurs, is a part of the primary mechanism and is not due to the intervention of any other factor, particularly the factor of infection.From the Beth Israel Hospital.