Analysis Of Influencing Factors And Outcome Of Neonatal Pneumothorax

Objective:To investigate the clinical characteristics and prognostic factors of neonatal pneumothorax.Methods:The clinical data of neonates admitted to the second neonatal ward of shengjing hospital affiliated to China medical university from January 2012 to December 2018 and diagnosed with pneumothorax were retrospectively analyzed.The children were divided into premature delivery group and full-term group according to their gestational age,and survival group and death group according to the outcome.Multivariate Logistic regression method was used to analyze the risk factors affecting pneumothorax death.Results:All patients were 150,male: female 2.06:1(101/49),and 14(9.3%)died.There were 60 cases(40%)of premature infants,ga28w-36 +6w,bw624g-4000 g,and 5 deaths(8.3%).There were 90 cases(60%),ga37w-42 +2w,bw2650g-4700 g,and 9 deaths(10.0%)in the term infant group.The proportion of premature rupture of membranes(26.7%)in the preterm group was significantly higher than that in the term group(12.2%),2=4.944,p<0.05.Postnatal recovery rate(26.6%)was significantly higher than that of full-term group(13.3%),2=4.215,p<0.05.The proportion of patients requiring positive pressure assisted ventilation(noninvasive + invasive)before diagnosis of pneumothorax(56.6%)was significantly higher than that of the full-term group(26.6%),2=13.800,p<0.05.The application ratio of pulmonary surfactant(PS)(30.0%)was significantly higher than that of the full-term group(3.3%),2=21.262,p<0.05.In the death group,the premature rupture time of membranes was more than 24 hours,the Apgar score was low,postpartum asphyxial resuscitation and prepneumothorax required respiratory support,and the mortality rate of pulmonary hemorrhage(57.1%,57.1%,64.3%,71.4%,42.9%)was significantly higher than that of the survival group(13.9%,7.4%,13.9%,35.3%,2.2%),respectively 15.858,29.796,21.168,6.989,36.904,p<0.05.The difference was statistically significant.Multivariate Logistic stepwise regression analysis of death showed that premature rupture of membranes was more than 24h(OR=1.2,95%CI3.8~3.9,p<0).05),low Apgar score(< 7)(OR=0.2,95%CI0.03~0.7,p<0.05),respiratory support(OR=2.4,95%CI1.3~4.6,p<0.05),pulmonary hemorrhage(OR=36.8,95%CI5.8~232.4,p<0.05)are independent risk factors associated with death.Conclusion:Prematurerupture of membranes,asphyxiation and resuscitation,application of PS and positive pressure ventilation ratio in the pneumothorax group were significantly higher than those in the full-term group.Premature rupture of membranes,low Apgar score,auxiliary ventilation and pulmonary hemorrhage were independent risk factors associated with death.