Pneumothorax in the newborn. Changing pattern.

The clinical course of pneumothorax and its allied conditions was studied in 34 newborn infants who presented over a 2 1/2-year period. We found an overall incidence of 3/1000 live births. 11 term infants without obvious pulmonary pathology presented early (9 within minutes of birth); 6 of these had aspirated meconium or blood. The remaining 23 were preterm infants with hyaline membrane disease (HMD) and accounted for 68% of the infants in this series. In contrast, they presented late (mean 45 hours) and 16 were on continuous distending pressure (CDP) or intermittent positive pressure ventilation (IPPV) at the onset of pneumothorax. 15% of all infants with HMD who required CDP/IPPV developed pneumothorax; this increased incidence was most evident in infants who received CDP only. All except 2 of the 11 term infants in the first group were managed conservatively and all survived. Wehn pneumothorax occurred as a complication of HMD in preterm infants, 14 of the 16 infants required intrapleural drainage. Persistence or recurrence of pneumothorax occurred in 9 infants, 7 of whom were receiving CDP/IPPV at the time. Lung expansion was affected only after replacement with a patent chest drain through the same incision or insertion of a second drain on the same side of the chest. All 5 deaths occurred in the group of preterm infants with HMD. 3 resulted directly form respiratory failure due to severe HMD complicated by pneumothorax. We emphasize the increasing importance of pneumothorax as a complication of HMD in preterm infants, particularly in those receiving CDP. Successful management depends on prompt diagnosis and treatment of pneumothorax, which may occur as unexplained sudden deterioration at any time during the course of illness in this group of high risk infants.