Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
LETTER TO EDITOR
Year : 2014  |  Volume : 41  |  Issue : 1  |  Page : 61-62

Management of spontaneous pneumothorax in a newborn: A rare clinical entity


1 Regional Hospital, Solan, Himachal Pradesh, India
2 Departments of Anaesthesiology and Intensive Care, Gian Sagar Medical College & Hospital, Banur, Punjab, India

Date of Web Publication7-Feb-2014

Correspondence Address:
Hemant Gupta
Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College & Hospital, Ram Nagar, Banur, Patiala, Punjab
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-5009.126763

Rights and Permissions

How to cite this article:
Gupta H, Anand S, Bajwa SS. Management of spontaneous pneumothorax in a newborn: A rare clinical entity. J Sci Soc 2014;41:61-2

How to cite this URL:
Gupta H, Anand S, Bajwa SS. Management of spontaneous pneumothorax in a newborn: A rare clinical entity. J Sci Soc [serial online] 2014 [cited 2019 May 26];41:61-2. Available from: http://www.jscisociety.com/text.asp?2014/41/1/61/126763

Sir,

The sudden unexpected development of spontaneous pneumothorax in a full-term, apparently healthy infant is rarely seen, though it is a well-known complication of the respiratory distress syndrome and its therapy. [1] Spontaneous pneumothorax that occurs during this period is mostly associated with assisted ventilation, birth trauma, meconium aspiration or prematurity. [2] We report the occurrence of spontaneous pneumothorax in a 3.5 kg healthy neonate born by spontaneous vaginal delivery at 38 weeks gestation in the absence of any known predisposing factors. The prenatal course was unremarkable with no evidence of chorioamnionitis, oligohydramnios or any systemic infection. Amniotic fluid did not show any staining with meconium and Apgar scores were eight and nine at 1 and 5 min, respectively. After delivery, the baby was active and showed no sign of respiratory distress, but the baby suddenly became lethargic and pale without any preceding clinical event 6 h after birth.

On admission to neonatal emergency unit, the neonate was lethargic, pale and had a respiratory rate of 72 breath/min, heart rate 172 beats/min, CFT <3 s, but peripheral pulses were palpable. On examination, the anterior fontanelle was normal, SpO 2 was 75% on room air and decreased breath sounds on the right side of the chest. The chest X-ray revealed pneumothorax on the right side with the shift to the left [Figure 1] while brain and abdominal sonograms were normal. The initial sepsis screen was negative, blood sugar and electrolytes were normal. The chest tube was inserted immediately on the right side and the baby had sudden improvement with SpO 2 >92% and respiratory rate <60 breaths/min and patient started accepting breast feeds. The repeat chest X-ray revealed normal findings and the child was discharged after 5 days [Figure 2]. The occurrence of spontaneous pneumothorax in a healthy newborn is a rare entity. [3] Most neonatal pneumothorax, pneumomediastinum and surgical emphysema in the neck occurs as a result of birth injury, shoulder dystonia, prematurity, pneumonia, meconium aspiration syndrome or assisted ventilation. [3],[4],[5] However, during normal delivery, when the term baby passes through the vagina, there are potential chances of his thoracic cage being over-compressed during the delivery. Under such circumstances, the pressure gradient between the alveolar and perivascular space can increase abnormally for a transient period that may possibly lead to the rupture of the alveoli. However, this condition may manifest several hours after birth and respiratory distress may develop, which is considered to be the most important presenting sign, as has been noted in the present case. Though renal anomalies are commonly associated in neonates with spontaneous pneumothorax or pneumomediastinum, abdominal ultrasonography did not reveal any congenital malformation of kidneys or any other intra-abdominal organs. [6],[7]
Figure 1: Chest X-ray revealing pneumothorax on the right side with the shift to the left

Click here to view
Figure 2: Chest X-ray revealing normal bilateral lung fields without any shift of the heart

Click here to view


In conclusion, spontaneous pneumothorax is a rare complication of vaginal delivery and respiratory distress in healthy newborn hours after delivery should always raise the suspicion of spontaneous pneumothorax.

 
  References Top

1.Yu VY, Liew SW, Robertson NR. Pneumothorax in the newborn. Changing pattern. Arch Dis Child 1975;50:449-53.  Back to cited text no. 1
    
2.Bodey GP. Medical mediastinal emphysema. Ann Intern Med 1961;54:46-56.  Back to cited text no. 2
    
3.Low AS, Tan-Kendrick AP, Loh M, Chui CH. Spontaneous multiloculated multiseptated pneumomediastinum in a newborn baby: The spinnaker sail is rigged-CT features with pathologic correlation. Pediatr Radiol 2003;33:712-5.  Back to cited text no. 3
    
4.Kacmarynski DS, Sidman JD, Rimell FL, Hustead VA. Spontaneous tracheal and subglottic tears in neonates. Laryngoscope 2002;112:1387-93.  Back to cited text no. 4
    
5.Ammari AN, Jen A, Towers H, Haddad J Jr, Wung JT, Berdon WE. Subcutaneous emphysema and pneumomediastinum as presenting manifestations of neonatal tracheal injury. J Perinatol 2002;22:499-501.  Back to cited text no. 5
    
6.Stern L, Fletcher BD, Dunbar JS, Levant MN, Fawcett JS. Pneumothorax and pneumomediastinum associated with renal malformations in newborn infants. Am J Roentgenol Radium Ther Nucl Med 1972;116:785-91.  Back to cited text no. 6
    
7.Yoo KH, Na HC, Kim MS, Lee HK, Lee HK. A case of spontaneous pneumomediastinum in children. J Korean Pediatr Soc 1987;4:427-30.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed6036    
    Printed32    
    Emailed1    
    PDF Downloaded443    
    Comments [Add]    

Recommend this journal