Pneumothorax - infantsDefinition: Pneumothorax is the collection of air or gas in the space around the lungs, which leads to a lung collapse. This article discusses pneumothorax in infants. For information about pneumothorax in older children and adults, see: Pneumothorax
Alternative Names: Air leak syndrome
Causes, incidence, and risk factors: A pneumothorax occurs when the tiny air sacs (alveoli) in a baby's lung burst, leaking air into the space between the lung and chest wall (pleural space). The most common cause of pneumothorax is a breathing machine (mechanical ventilator). Sometimes premature newborns and those with breathing problems are put on a breathing machine. The machine puts extra pressure on the baby's lungs, which can sometimes burst the air sacs. As the baby is being born, it is possible for the baby to breathe in the first bowel movement, called meconium , and this can also lead to pneumothorax. The meconium can plug up the airways and irritate and inflame the lung tissue, which can cause air to leak. See also: Meconium aspiration syndrome In some cases, an otherwise healthy baby can develop an air leak when he or she takes the first few breaths after birth. This occurs because of the pressure needed to expand the lungs for the first time. The following conditions also increase a baby's risk for pneumothorax: Pneumothorax is more common in boys than girls.
Symptoms: Many infants do not have symptoms. When symptoms do occur, they can include: - Bluish skin color (cyanosis)
- Fast breathing
- Flaring of the nostrils
- Grunting with breathing
- Irritability
- Restlessness
- Use of other chest and abdominal muscles to aid breathing (retraction)
Signs and tests: The doctor may have difficulty hearing breath sounds when listening to the infant's lungs with a stethoscope. The heart or lung sounds may seem as if they are coming from a different part of the chest than normal. Tests for pneumothorax include: - Chest x-ray
- Light probe placed against the baby's chest (pockets of air will show up as lighter areas)
Treatment: Babies without symptoms may not need treatment. The health care team will monitor your baby's breathing, heart rate, and color. If your baby is having symptoms, the doctor will place a needle or thin tube called a catheter into the baby's chest to remove the air that has leaked into the chest space. Treatment can last for a few days to a few weeks.
Expectations (prognosis): Some air leaks will go away on their own within a few days without treatment. Infants who are treated by removing the air with a needle or catheter usually do well after treatment.
Complications: Although babies on breathing machines are carefully watched, air leaks can occur. As air builds up in the chest, it can push the heart toward the other side of the chest. This puts pressure on both the lung that hasn't collapsed and the heart. This condition is called tension pneumothorax. It is a medical emergency.
Calling your health care provider: Often pneumothorax is discovered shortly after the baby is born. Call your health care provider if your infant has symptoms of pneumothorax.
Prevention: The health care providers in the newborn intensive care unit (NICU) should watch your infant carefully for signs of an air leak.
References: Mason RJ, Murray JF, Broaddus VC, Nadel JA. Murray & Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders; 2005. Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician, 2007;76:987-994.
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