Pneumothorax in Newborn

Pneumothorax is a buildup of air between a lung and the chest wall. A baby’s lungs have tiny air sacs (alveoli). If one or more of these alveoli break, air can leak out of the baby’s lung and into the chest cavity that holds the lung. As air leaks out, part of the lung can collapse.

This makes it hard for the baby to breathe. If a lung collapses completely, it can put pressure on the heart and on the other lung. This is a life-threatening condition. It is called a tension pneumothorax.

What are the causes?

This condition is caused by air leaking out of the lungs. This may be caused by:

• Respiratory distress syndrome. This condition usually develops in babies who are born too early (premature). A premature baby’s lungs are not fully developed. They may not have enough of a slippery substance that lubricates the lungs (surfactant). This makes it hard for the baby to breathe.
• Assisted breathing with a machine shortly after birth. This may over-inflate the baby’s lungs and cause alveoli to burst.
• Lung irritation. This can happen when a baby inhales some of the first bowel movement during birth (meconium aspiration).
• Lung infection (pneumonia).
• Underdeveloped lung tissue (pulmonary hypoplasia).

This condition can also happen for no known reason (spontaneous pneumothorax).

What increases the risk?

A baby is more likely to develop this condition if he or she:

• Is born early (prematurely).
• Has had pneumothorax in the past. Newborns who have had one pneumothorax are also at increased risk for having another.

What are the signs or symptoms?

Symptoms of this condition depend on the severity of the pneumothorax. If only part of the lung collapses, there may be no symptoms. If a lung collapses completely, it may cause the following symptoms:

• Rapid breathing.
• Grunting noises while breathing.
• Flaring of the nostrils.
• Noticeable sucking of the skin into the spaces between the ribs while your baby struggles to breathe (chest retractions).
• Irritability.
• Poor feeding.
• Skin that has a blue tint (cyanosis).

How is this diagnosed?

Your baby’s health care provider may suspect pneumothorax if your baby is struggling to breathe. Your baby’s health care provider will also do a physical exam. This may include:

• Testing for reduced breath sounds.
• Testing for low blood pressure.
• Shining a light through your baby’s chest (transillumination) to check for light areas where the lung should be.
• A chest X-ray to confirm the diagnosis.

How is this treated?

Treatment for this condition depends on the severity of the pneumothorax.

• If the pneumothorax is not causing symptoms, the health care provider may give your baby extra oxygen to breathe. The health care provider will also check your baby’s oxygen level, heart rate, and blood pressure often.
• If the pneumothorax is making it hard for your baby to breathe, your baby may need to have a procedure in which a needle or a tube (chest tube) is used to remove the air in the chest cavity. The chest tube may need to stay in place for several days. Your baby will stay in the hospital during that time.
• Your baby can go home when he or she is breathing normally and when the pneumothorax is gone or controlled.

Follow these instructions at home:

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin because of the association with Reye syndrome.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your baby is irritable.
• Your baby is not feeding well.

Get help right away if your baby:

• Has trouble breathing.
• Has fast breathing.
• Makes grunting noises, or has flaring of the nostrils, while breathing.
• Has sucking of the skin into the spaces between the ribs while struggling to breathe (chest retractions).
• Has cyanosis around the lips.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

• Pneumothorax is a buildup of air between a lung and the chest wall.
• This condition may be caused by respiratory distress syndrome, irritation and infection of the lung, and use of a machine for assisted breathing.
• Your baby’s health care provider may suspect pneumothorax if your baby is struggling to breathe.
• Treatment for this condition depends on the severity of the pneumothorax. It may include giving oxygen or using a needle or a chest tube to remove air from the chest cavity.