The High Risk Factors For The 60 Cases Of Neonatal Pneumothorax

Pneumothorax in newborn is the disease which appears dyspnea because of the alveoli of lung hyperdistension and disruption, the gas entered the cavitas pleuralis. It is clinical emergency case which often happened in neonatal intensive care unit, and incidence rate is about 0.05-2%.Comparing with adult and children, the lungs of newborn infant especially during perinatal period are immaturity. Their lung tissues are tenuity, flexibility of pulmonary alveoli is weak and alveolar pores less, so when the intrapulmonary pressure increased, the gas can't transmit to the vicinal alveoli and pneumothorax happened. Pneumothorax of newborn is divided to three kinds including spontaneous pneumothorax, pathological pneumothorax and iatrogenic pneumothorax. Manifestation: distress of respiratory, grunting, cyanosis, restlessness, tachypnea, three depressions sign, bony thorax dyssymmetry, low breath sound, transcutaneous oxygen saturation fluctuate and so on. Pneumothorax can aggravat the patient's condition, cause many complications, extend length of stay and increase cost of hospitalization. Tension pneumothorax is often dangerous, when it happened, the compression areas of lungs were large. It is easy to cause mediastinal shift, heart compression which can induce bradycardia and hypotension, even cardiac arrest. Death rate is 16%. Therefore, if we understand general features of neonatal pneumothorax and recognize its high risk factors ,we can prevent it effectively, discover it early and treat it promptly.The objective is to explore the clinical features and correlated high risk factors, provide theory and clinical instruction to preventing neonatal pneumothorax.We studied 60 neonates with pneumothorax diagnosed by clinical features and chest X-ray admitted between February, 2007 to January, 2009. Among the total, 21 patients'were preterm infant, including 4 patients'gestation age was less than 30 weeks, 8 patients'gestation age was less 34 weeks but exceeded 30 weeks, 9 patients'gestation age was less 37 weeks but exceeded 34 weeks, and the other 39 patients were term infants. We also randomly selected 120 neonatal infants without pneumothorax at the same period as the control group. Among the total, 8 patient's gestation age was less than 30 weeks, 16 patients'gestation age was less 34 weeks but exceeded 30 weeks, 18 patients'gestation age was less 37 weeks but exceeded 34 weeks, and 78 patients'gestation age exceeded 37 weeks. We analyzed 20 factors with the method of single and multiply-factor analysis: mothers with disease of pregnancy-induced hypertension syndrome or diabetes mellitus, the patient's gestational age, birth weight , gender, mode of delivery, whether have labor symptom, placenta, umbilical cord, whether have meconium amniotic fluid, intrauterine embarrassment ,asphyxia, multiple gestation, whether have acidosis, wet lung of the newborn, neonatal pneumonia, respiratory distress syndrome, meconium aspiration syndrome, suction, continuous positive airway pressure, mechanical ventilation et al. Through single-factor and multiple-factors analysis we discuss the high risk factors for pneumothorax. All the collected clinical data is compared and analyzed statistically with SPSS 12.0 software , admitted P<0.05 is significant.Results: The incidence of neonatal pneumothorax is 1.3%, and the preterm and term infants have no significant predictors. During the 60 cases of pneumothorax , 6 cases happened in bilateral, accounting 10% and 54 cases happened in unilateral, accounting 90%. Among the total, right lateral account 58% and left lateral account 32%. 54% of the disease happened in 1 day after birth, 43% happened between 2 and 7 days, and 3% happened exceeded 7 days. 9 infants of the 60 infants died, including 7 cases of preterm infants and 2 cases of term infants. Death rate is 15%.The death rate between preterm and term infants have significant difference. In univariate of statistical analysis the above , mothers with disease of PIH or DM, gestational age, birth weight , gender, mode of delivery, placenta, umbilical cord, whether have meconium amniotic fluid, intrauterine embarrassment , asphyxia, multiple gestation, whether have acidosis, MAS have no significant difference. whether have labor symptom, wet lung of the newborn, neonatal pneumonia, RDS, suction, continuous positive airway pressure, mechanical ventilation have significant difference. In multivariate of statistical analysis, whether have labor symptom(OR=4.152 ,95%CI=1.819-9.478), whether have wet lung of the newborn(OR=10.229, 95%CI=3.105- 33.694), neonatal pneumonia(OR= 14.209 , 95%CI=1.751 -42.499), RDS(OR=9.726,95%CI= 1.531-61.755), MAS (OR=7.031, 95%CI= 1.291- 38.208), mechanical ventilation (OR= 4.323,95%CI=0.042-0.898) have significant difference, which are the in- dependence high risk factors of the pneumothorax.Conclusions: Incidence and fatality of neonatal pneumothorax is high. whether have labor symptom, wet lung of the newborn, neonatal pneumonia, respiratory distress syndrome, meconium aspiration syndrome, mechanical ventilation are close to pneumothorax. We should monitor these conditions intimately, do the perinatal care, handle uterine-incision delivery indication and adjust parameter of breathing machine. In addition, some relative research manifested other factors that have no statistical significance with neonatal pneumothorax analyzed by our medical case statistics are related with pneumothorax. So we should also pay attention to other factors.