A pneumothorax in a newborn occurs when air escapes from the lung and collects in the pleural space, the area between the lung and the chest wall. This air accumulation can cause the lung to partially or fully collapse. While the term may sound concerning, it is a recognized medical condition that healthcare professionals are prepared to manage in newborns. This condition occurs more frequently in the neonatal period than at any other time in life.
Causes of Pneumothorax in Newborns
Pneumothorax in newborns can arise from various factors, broadly categorized as spontaneous or secondary to other medical conditions. Spontaneous pneumothorax occurs in healthy, full-term infants without any obvious underlying lung disease or clear precipitating factor. This type is thought to result from significant pressure changes during a baby’s first breaths as their lungs expand. The incidence in term newborns is approximately 1% to 2%.
Secondary causes are linked to existing medical issues. Respiratory Distress Syndrome (RDS) is a common underlying cause, especially in premature infants whose lungs lack sufficient surfactant. Meconium aspiration syndrome (MAS), where a baby inhales meconium, can obstruct airways and lead to pneumothorax. Congenital lung abnormalities or conditions like pulmonary hypoplasia, where lung development is incomplete, can also predispose newborns to this condition.
A pneumothorax can also be an iatrogenic cause, meaning it results from necessary medical interventions. Mechanical ventilation, which uses positive pressure to help a baby breathe, can sometimes cause barotrauma, leading to the rupture of tiny air sacs (alveoli) and a subsequent air leak. The incidence in infants receiving positive-pressure ventilation can range from 15% to 30%. Continuous positive airway pressure (CPAP) can also increase the risk in preterm infants with RDS.
Identifying a Collapsed Lung in an Infant
Recognizing a collapsed lung in an infant involves observing specific signs of breathing difficulty and utilizing diagnostic imaging. Healthcare providers look for symptoms such as tachypnea, which is rapid breathing, and audible grunting noises with each breath. Other indications include nasal flaring, where the nostrils widen with each inhalation, and retractions, a visible sinking in of the chest wall, particularly between the ribs or at the base of the neck, as the baby struggles to breathe. A bluish tint to the skin and lips, known as cyanosis, can also be present, indicating inadequate oxygenation.
When a pneumothorax is suspected, a definitive diagnosis is made through a chest X-ray. This imaging technique is considered the gold standard because it clearly shows the presence of air outside the lung in the pleural space, allowing doctors to assess the extent of the collapse. In emergency situations, transillumination can be used as a rapid diagnostic tool. This involves shining a bright light through the infant’s chest, which can reveal a brighter glow on the affected side due to the air pocket scattering the light.
Treatment for a Newborn’s Collapsed Lung
Treatment for a newborn’s collapsed lung varies based on the size of the air leak and the baby’s symptoms. For small air leaks causing no symptoms, conservative management is often employed. This involves “watchful waiting,” where medical staff monitor the baby, allowing the body to reabsorb the trapped air. Administering supplemental oxygen, specifically 100% oxygen, can help speed up the reabsorption process.
If the pneumothorax is larger or causes mild symptoms, needle aspiration, also known as thoracentesis, may be performed. This procedure involves inserting a small needle into the chest to draw out accumulated air, helping the lung re-expand. It is a less invasive option that can provide immediate relief.
For more significant air leaks or if the baby is experiencing severe breathing difficulties, chest tube insertion is the most comprehensive treatment. A small, flexible tube is placed into the pleural space through an incision in the chest wall. This tube remains in place for several days, connected to a drainage system, to continuously remove air and allow the lung to fully re-expand. The tube is removed once the air leak resolves and the lung remains expanded.
Recovery and Long-Term Outlook
For the majority of newborns experiencing a pneumothorax, especially those with a spontaneous occurrence, the recovery is generally favorable once the lung has re-expanded. During the hospital stay, after any interventions like chest tube removal, the baby will be continuously monitored to ensure the lung remains fully inflated and there are no further air leaks. This observation period is crucial for confirming stability before discharge.
In most instances, a single episode of pneumothorax in a newborn does not result in lasting lung damage or long-term health complications. The focus of follow-up care is typically on addressing any underlying medical conditions that may have contributed to the pneumothorax, rather than the pneumothorax itself. Babies usually recover completely and experience normal lung function as they grow.