doiSerbia

Pulmonary air leak syndrome in term and late preterm neonates

Marković-Sovtić Gordana (Dr. Vukan Čupić Mother and Child Health Care Institute, Belgrade, Serbia)
Nikolić Tatjana (Clinical Center of Serbia, Clinic for Obstetrics and Gynecology, Belgrade, Serbia)
Sovtić Aleksandar (Dr. Vukan Čupić Mother and Child Health Care Institute, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Martić Jelena (Dr. Vukan Čupić Mother and Child Health Care Institute, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia)
Rakonjac Zorica (Dr. Vukan Čupić Mother and Child Health Care Institute, Belgrade, Serbia)

Introduction/Objective. Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods. Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results. Eighty-seven neonates of an average gestational age 38.1 ± 1.9 g.w. were included in the study. The average birth weight was 3182.5 ± 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion. Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group.

Keywords: pneumothorax, newborn, respiratory insufficiency, mechanical ventilation