Characteristics of Pneumothorax in a Neonatal Intensive Care Unit
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Purpose: The development of postnatal pneumothorax and its common causes and clinical aspects were studied to promote early diagnosis and proper management. Methods: A retrospective study of neonates who were hospitalized in the neonatal intensive care unit at Soonchunhyang University Bucheon Hospital from 2001 to 2010 was performed. Term neonates were divided into a spontaneous pneumothorax group and a secondary pneumothorax group. The secondary group was divided into term and preterm groups. Results: Of 4,414 inpatients, 57 (1.3%) were diagnosed with pneumothorax. Of term newborn patients, 28 (80%) had a secondary pneumothorax, and seven (20%) had a spontaneous pneumothorax. No differences were observed for gender, birth weight, resuscitation,or duration of admission between the spontaneous and control groups. The duration of treatment with a thoracostomy (20 patients, 57%) was longer in the spontaneous group (5.4±2.9 days vs. 2.7±2.0 days) than that in the control group. Patients with respiratory distress syndrome (RDS) developed a pneumothorax 22.8 hours after surfactant treatment, whereas patients with transient tachypnea of the newborn (TTN), pneumonia, and meconium aspiration syndrome (MAS) developed pneumothorax after 16.6 hours. Of 50 patients with a secondary pneumothorax, 19 (38%) had RDS, 11 (22%) had MAS, 7 (14%) had TTN, and six (12%)had pneumonia. Among term newborns, 42.9% were treated only with 100% oxygen. Among preterm newborns, 72.6% and 27.3% needed a thoracostomy or ventilator care, respectively. Conclusion: A pneumothorax is likely to develop when pulmonary disease occurs in neonates. Therefore, it is important to carefully identify pneumothorax and provide appropriate treatment.
Abstract
Purpose: The development of postnatal pneumothorax and its common causes and clinical aspects were studied to promote early diagnosis and proper management. Methods: A retrospective study of neonates who were hospitalized in the neonatal intensive care unit at Soonchunhyang University Bucheon Hospital from 2001 to 2010 was performed. Term neonates were divided into a spontaneous pneumothorax group and a secondary pneumothorax group. The secondary group was divided into term and preterm groups. Results: Of 4,414 inpatients, 57 (1.3%) were diagnosed with pneumothorax. Of term newborn patients, 28 (80%) had a secondary pneumothorax, and seven (20%) had a spontaneous pneumothorax. No differences were observed for gender, birth weight, resuscitation,or duration of admission between the spontaneous and control groups. The duration of treatment with a thoracostomy (20 patients, 57%) was longer in the spontaneous group (5.4±2.9 days vs. 2.7±2.0 days) than that in the control group. Patients with respiratory distress syndrome (RDS) developed a pneumothorax 22.8 hours after surfactant treatment, whereas patients with transient tachypnea of the newborn (TTN), pneumonia, and meconium aspiration syndrome (MAS) developed pneumothorax after 16.6 hours. Of 50 patients with a secondary pneumothorax, 19 (38%) had RDS, 11 (22%) had MAS, 7 (14%) had TTN, and six (12%)had pneumonia. Among term newborns, 42.9% were treated only with 100% oxygen. Among preterm newborns, 72.6% and 27.3% needed a thoracostomy or ventilator care, respectively. Conclusion: A pneumothorax is likely to develop when pulmonary disease occurs in neonates. Therefore, it is important to carefully identify pneumothorax and provide appropriate treatment.
참고문헌 (25)
- Posner K, "Pneumothorax", Pediatr Rev, 29, pp.69~70 (2008)
- Klinger G, "Risk factors for pneumothorax in very low birth weight infants", Pediatr Crit Care Med, 9, pp.398~402 (2008)
- Zenciroğlu A, "Evaluation of predisposing and prognostic factors in neonatal pneumothorax cases", Tuberk Toraks, 54, pp.152~156 (2006)
- Primhak RA, "Factors associated with pulmonary air leak in premature infants receiving mechanical ventilation", J Pediatr, 102, pp.764~768 (1983)
- Litmanovitz I, "Expectant management of pneumothorax in ventilated neonates", Pediatrics, 122, pp.e975~e979 (2008)
- Katar S, "Symptomatic spontaneous pneumothorax in term newborns", Pediatr Surg Int, 22, pp.755~758 (2006)
- Fanaroff AA, "Trends in neonatal morbidity and mortality for very low birthweight infants", Am J Obstet Gynecol, 196, pp.147~ (2007)
- 주지원, "증상이 있는 신생아 자발성 기흉의 관련 질환과 예후", 대한신생아학회지, 15(2), pp.166~171 (2008), 대한신생아학회
- Smith J, "Clinical course of symptomatic spontaneous pneumothorax in term and late preterm newborns: report from a large cohort", Am J Perinatol, 28, pp.163~168 (2011)
- Verma RP, "Risk factors and clinical outcomes of pulmonary interstitial emphysema in extremely low birth weight infants", J Perinatol, 26, pp.197~200 (2006)
- Verder H, "Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish- Swedish Multicenter Study Group", N Engl J Med, 331, pp.1051~1055 (1994)
- Dani C, "Early extubation and nasal continuous positive airway pressure after surfactant treatment for respiratory distress syndrome among preterm infants <30 weeks' gestation", Pediatrics, 113, pp.e560~e563 (2004)
- Escobedo MB, "Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial", J Pediatr, 144, pp.804~808 (2004)
- Reininger A, "Surfactant administration by transient intubation in infants 29 to 35 weeks' gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: a randomized controlled trial", J Perinatol, 25, pp.703~708 (2005)
- Madansky DL, "Pneumothorax and other forms of pulmonary air leak in newborns", Am Rev Respir Dis, 120, pp.729~737 (1979)
- 정지선, "호흡곤란증후군과 폐렴에 의한 신생아 기흉의 임상적 특성", Korean Journal of Pediatrics, 52(3), pp.310~314 (2009), 대한소아과학회
- Choi BJ, "Clinical study of outcome and predisposing factors for spontaneous pneumothorax in the neonates", Korean J Perinatol, 11, pp.438~444 (2000)
- Powers WF, "Prognostic implications of age at detection of air leak in very low birth weight infants requiring ventilatory support", J Pediatr, 123, pp.611~617 (1993)
- Bashour BN, "Urinary tract anomalies in neonates with spontaneous pneumothorax and", or pneumonediastrnum, 1977, pp.59(Suppl), 1048~1049
- Al Tawil K, "Symptomatic spontaneous pneumothorax in term newborn infants", Pediatr Pulmonol, 37, pp.443~446 (2004)
- Steinhart JM, "Ultrasound screening of healthy infants for urinary tract abnormalities", Pediatrics, 82, pp.609~614 (1988)
- Mehrabani D, "Association of pneumothorax and hypotension with intraventricular haemorrhage", Arch Dis Child, 66, pp.48~51 (1991)
- Shin SH, "Comparison of therapeutic effects and complications between pigtail catheter and conventional tube thoracotomy for pneumothorax in neonates", J Korean Soc Neonatol, 6, pp.24~29 (1999)
- Esme H, "The factors affecting persistent pneumothorax and mortality in neonatal pneumothorax", Turk J Pediatr, 50, pp.242~246 (2008)
- Navaei F, "Predisposing factors, incidence and mortality of pneumothorax in a neonatal intensive care unit in Isfahan, Iran", Zhongguo Dang Dai Er Ke Za Zhi, 12, pp.417~420 (2010)