Risk Factors of Pneumothorax during the First 24 Hours of Life
Sopapan Ngerncham MD*, Pornpat Kittiratsatcha MD*, Preeyacha Pacharn MD**
Affiliation : *Department of Pediatrics, **Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Pneumothorax is one of the air leak syndrome and is more common in the newborn period than
in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumotho-
rax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays
and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneu-
mothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline
to prevent this condition.
Materials and Methods : This is a retrospective case-control study. Cases were infants with the diagnosis of
pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and Decem-
ber 2004. Controls were those whose birth times followed in the immediate chronology to the cases. Case:control
ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence
interval were used to identify possible risk factors. Statistical significance was considered as p < 0.05.
Results : There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence
interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight
(19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0),
low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure
ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal
care (3.5; 1.04, 11.9).
Conclusion : All pregnant women should be encouraged to have good antenatal care. Mother who has
complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression.
For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium
after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resusci-
tation, when needed, should be done very carefully by following the American Heart Association and the
American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.
Keywords : Pneumothorax, Newborn, Risk factors
