Pneumothorax bij preterme neonaten met hyaliene membranenziekte: risicofactoren en gevolgen.

OBJECTIVE: Analysis of risk factors and consequences of a pneumothorax in ventilated preterm neonates with hyaline membrane disease (HMD). PATIENTS AND METHODS: In 88 neonates with HMD (gestational age 29.7 +/- 2.5 weeks, birth weight 1370 +/- 510 gram) clinical parameters as grade of HMD, ventilator settings, the administration of sedative and/or paralysing drugs, and the occurrence of patent ductus arteriosus (PDA) had been studied retrospectively to assess possible risk factors for a pneumothorax. The effects of a pneumothorax on neuromotor development and the occurrence of bronchopulmonary dysplasia (BPD) were also studied. Newborns with signs of infection were excluded. RESULTS: A pneumothorax occurred in 25 of the 88 (28%) ventilated infants with HMD. The other 63 newborns formed the control group. The grade of HMD was similar for both groups. The ventilator settings (max. frequency, max. inspiratory pressure and max. inspiratory time) before the occurrence of a pneumothorax or up to the third day of life were not significantly different between the groups. Interstitial emphysema occurred more often in the pneumothorax group (32% re 2%, P < 0.01). Eleven of the 25 (44%) with a pneumothorax died compared to 8 of the 63 (13%) infants without a pneumothorax (p < 0.05). Neuro-development differed not significantly between both groups. BPD was seen more frequently after pneumothorax than in the control group 79% re 47% (p < 0.05, Chi2-test). CONCLUSIONS: A pneumothorax results in an increased mortality and incidence of BPD. Interstitial emphysema occurred more often in the pneumothorax group. None of the other variables studies could be assigned as a risk factor for a pneumothorax.