Raffaella Panza1, Giorgia Prontera2, Kevin Nicholas Ives3, Sanja Zivanovic3,4, Charles C Roehr3,4, Michele Quercia2, Federico Schettini2, Francesco Paolo Bianchi5, Silvio Tafuri5, Antonio Di Mauro2, Nicola Laforgia2. 1. Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, University of Bari "Aldo Moro", Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy. raffaella.panza@uniba.it. 2. Department of Biomedical Science and Human Oncology, Neonatology and Neonatal Intensive Care Section, University of Bari "Aldo Moro", Policlinico Hospital - Piazza Giulio Cesare n. 11, 70124, Bari, Italy. 3. Newborn Services, John Radcliffe Hospital, NHS Foundation Trust, Oxford University Hospitals, Oxford, UK. 4. University Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK. 5. Department of Biomedical Science and Human Oncology, Section of Hygiene, University of Bari "Aldo Moro", Bari, Italy.
Abstract
Pneumothorax in newborns can be life-threatening. The traditional treatment of pneumothorax is chest drain placement. Recently, modified pigtail catheter has been proposed as a less traumatic approach despite limited experience in infants. To compare the effectiveness and safety of pigtail catheters versus traditional straight chest drains in term and preterm infants with pneumothorax, in two tertiary neonatal units: Policlinico Hospital in Bari, IT and John Radcliffe Hospital in Oxford, UK. We retrospectively reviewed medical records of 47 newborns with pneumothorax admitted to the two units between October 2009 and June 2017, and treated with either pigtail catheters or straight chest drains. Three newborns (6.7%) were excluded from the study because they were treated with both types of drains. The remaining 44 neonates were included in the analysis. Overall, 56.8% (n = 25/44) of pneumothoraces were drained with pigtail catheters and 43.2% (n = 19/44) with straight drains. No differences in gestational age and birth weight were found. The success rate, defined as complete radiological resolution of the pneumothorax after drainage, was significantly higher in the pigtail group (96.0% versus 73.7%; p < 0.05). Days of drainage, length of hospital stay and duration of respiratory support were not significantly different. Subcutaneous emphysema and drain dislodgement/malfunction occurred only in the straight drain group (0.0% versus 11.1%; p = 0.181). No significant differences in mortality between the two groups were found (28.0% pigtail group versus 26.3% straight drain group; p > 0.05). Conclusion: Pigtail catheters are a safe and effective alternative to traditional chest drains for infants with pneumothorax. What is Known:• Air leaks in newborns can represent an emergency, especially among preterms;• The first treatment in a life-threatening pneumothorax is thoracentesis with needle aspiration or placement of a chest drain.What is New:• Pigtail catheter have been described as an alternative to traditional chest drains;• Pigtail catheters are a safe and effective alternative to traditional chest drains for infants with pneumothorax.
Pneumothorax in newborns can be life-threatening. The traditional treatment of pneumothorax is chest drain placement. Recently, modified pigtail catheter has been proposed as a less traumatic approach despite limited experience in infants. To compare the effectiveness and safety of pigtail catheters versus traditional straight chest drains in term and preterm infants with pneumothorax, in two tertiary neonatal units: Policlinico Hospital in Bari, IT and John Radcliffe Hospital in Oxford, UK. We retrospectively reviewed medical records of 47 newborns with pneumothorax admitted to the two units between October 2009 and June 2017, and treated with either pigtail catheters or straight chest drains. Three newborns (6.7%) were excluded from the study because they were treated with both types of drains. The remaining 44 neonates were included in the analysis. Overall, 56.8% (n = 25/44) of pneumothoraces were drained with pigtail catheters and 43.2% (n = 19/44) with straight drains. No differences in gestational age and birth weight were found. The success rate, defined as complete radiological resolution of the pneumothorax after drainage, was significantly higher in the pigtail group (96.0% versus 73.7%; p < 0.05). Days of drainage, length of hospital stay and duration of respiratory support were not significantly different. Subcutaneous emphysema and drain dislodgement/malfunction occurred only in the straight drain group (0.0% versus 11.1%; p = 0.181). No significant differences in mortality between the two groups were found (28.0% pigtail group versus 26.3% straight drain group; p > 0.05). Conclusion: Pigtail catheters are a safe and effective alternative to traditional chest drains for infants with pneumothorax. What is Known:• Air leaks in newborns can represent an emergency, especially among preterms;• The first treatment in a life-threatening pneumothorax is thoracentesis with needle aspiration or placement of a chest drain.What is New:• Pigtail catheter have been described as an alternative to traditional chest drains;• Pigtail catheters are a safe and effective alternative to traditional chest drains for infants with pneumothorax.
Authors: Avroy A Fanaroff; Barbara J Stoll; Linda L Wright; Waldemar A Carlo; Richard A Ehrenkranz; Ann R Stark; Charles R Bauer; Edward F Donovan; Sheldon B Korones; Abbot R Laptook; James A Lemons; William Oh; Lu-Ann Papile; Seetha Shankaran; David K Stevenson; Jon E Tyson; W Kenneth Poole Journal: Am J Obstet Gynecol Date: 2007-02 Impact factor: 8.661