Pneumothorax and other forms of pulmonary air leak in newborns

A retrospective review was performed of the records of 222 infants to survey the entire spectrum of pulmonary air leak (used to indicate alveolar rupture, because for many sick infants with lung rupture who are breathing O₂ mixtures, 'air' leak is a slight misnomer) during a 21-month period in the Special Care Nursery at the Boston Hospital for Women. Of the 119 infants with hyaline membrane disease, 27% developed alveolar rupture. Of these, 24% developed air leak during treatment with O₂ alone, 16% during treatment with continuous positive airway pressure, and 34% during treatment with intermittent mandatory ventilation. Chest tubes for pleural drainage of air were used for 17, 13, and 15% of the infants in these treatment groups. The incidence of air leak was greatest in the more immature infants of lower birth weight. In those infants with a birth weight less than 1.5 kg, alveolar rupture was associated with a 68% mortality rate, as compared to 36% in those infants without alveolar rupture. Of the 32 infants with meconium aspiration pneumonia, 41% developed air leak, all during the first 24 h of life (mean age at rupture, 9.3 ± 2.0 h). Of the 50 infants with transient tachypnea of the newborn, 10% had air leak, which occurred at a mean postnatal age of 12.6 ± 4.7 h). 21 additional instances of air leak are reported, 14 of which occurred in term infants who were otherwise healthy. Pulmonary air leak is associated with signficant morbidity and mortality in newborns. Most events appear to be spontaneous rather than iatrogenic, which suggests that only by prevention of predisposing respiratory disease will there be a significant decrease in the incidence of this complication.