Pneumothorax in Neonates during Respiratory Support: Incidence, Timing, and Association with Mortality and Invasive Ventilation

Abstract

Aim: Pneumothorax , while a serious adverse event primarily associated with positive pressure respiratory support, is not well documented.  Our aim was to document the incidence and timing of pneumothorax, as well as its association with initial mode of ventilation (invasive or noninvasive) and mortality. Methods: We analyzed a database documenting the course of care and outcome of every neonate requiring noninvasive or invasive ventilation in one region of Poland (18 centers) over a 7-year period (5,551 cases). Results: The incidence in all infants was 5.1%. It was 7.2% in those initially treated with invasive ventilation, and 3.6% for those initially treated with noninvasive ventilation (p<0.001). The incidence of pneumothorax was also associated with an increased risk of mortality (11.4% vs 4.5% p<0.001). These both remained significant after controlling for baseline risk factors. Except for the intubated neonates >36 weeks EGA, the pneumothorax primarily occurred during the initial mode of ventilation and in the early days of respiratory support. Conclusıon: Significant pneumothorax tends to occur early in the course of respiratory support. It is more likely to be associated with invasive than noninvasive ventilation and is associated with a marked increased risk of mortality.