Pneumothorax in mechanically ventilated neonates Cairo university: two years study

ABSTRACT

Pneumothorax is a severe complication of pulmonary disease in newborn infants. It is often related to therapeutic procedures such as resuscitation and mechanical ventilation. Aim of this study was to detect the incidence of pneumothorax in mechanically ventilated neonates in the Neonatal Intensive Care Unit [NICU] -Cairo University and determine their associated risk factors. A retrospective study conducted in the NICU Children's Hospital-Cairo University during the period from January 2007 to December 2008. Files of 633/3321[19.06%] neonates receiving assisted ventilation were studied for presence of a radiological evidence of air leaks. Accordingly, they were classified into 2 groups Group I including neonates with evidence of pneumothorax, and Group II including those with no evidence of pneumothorax. Results detected pneumothorax in 26/633[4.10%] of ventilated neonates. There were statistical significant differences between both groups in Mean birth weight which was1.47 +/- 0.58 kg in group I versus 2.48 +/- 0.77 kg in group II with P value<0.001 highly significant [HS], mean duration of Ventilation which was 13.15 +/- 8.61 days in group I versus 7.13 +/- 6.56 days in group II with P value<0. 001 [HS], days in group II with P value<0.001[HS], and outcome as 20/26[76.92%] neonates of group I died and 319/607[52.90%] of group II died with P value<0.001[HS]. Twenty one out of twenty six [80.76%] neonates were diagnosed as respiratory distress syndrome [RDS], while 5126 [19.23%] were meconium aspiration syndrome. The highest percentage of pneumothorax was observed in neonates receiving SIMV from the start of ventilation 15126 [57.69%], followed by those receiving NCPAP then SIMV 10126 [38.46%], and only in 1 neonate receiving NCPAP only[3.84%] with P value 0.032[Significant]. FIO2 was higher in group I compared to group II 51.54 +/- 23.14 versus 35.09 +/- 19.10; P value<0.001[HS]. PIP was higher in group I than group II 25.16 +/- 5.79 cm H20 versus20.82 +/- 4.57 cm H20; P value 0.01 [S]. Respiratory rate was higher in group I versus group II 41.40 +/- 10.93 versus 34.55 +/- 11.65 ; P value 0.01 [S]