An abrupt increment in the respiratory rate is a sign of neonatal pneumothorax.

OBJECTIVE: The objective of the present study was to investigate the early clinical signs of neonatal pneumothorax. METHODS: A case-control study at a level III referral center from 2006 to 2012 was conducted. For each neonate with pneumothorax (Group I), one control subject (Group II) was identified by selecting an infant born within the same week with a gestational age of ± 7 days and with a birth weight within 10% of the index case. The primary outcome was to investigate the clinical findings preceding the onset of pneumothorax. Secondary outcome was to assess the risk factors. RESULTS: Of the 1375 infants admitted, 39 had a pneumothorax. Patients with pneumothorax showed significantly increased respiratory rates preceding the definitive diagnosis when compared with control patients (median: 16 (0-58) versus 4 (0-10); p < 0.001). An increase in the respiratory rate was found to be a significant clinical parameter preceding the diagnosis of pneumothorax (odds ratio (OR): 1.47, 95% confidence interval (CI): 1.12-2.14, p < 0.001; R(2) = 0.80). Sensitivity and specificity of this sign were found to be 77 and 90%, respectively. CONCLUSION: An abrupt increase in the respiratory rate would be used as a reliable parameter to help determine an impending pneumothorax in neonates.

The utility of special radiological signs on routinely obtained supine anteroposterior chest radiographs for the early recognition of neonatal pneumothorax.

BACKGROUND: Bedside chest radiographs used for the confirmation of diagnosis of pneumothorax in the neonatal intensive care unit (NICU) are routinely obtained in the supine position. However, pneumothoraces may not appear in the classically described forms on these radiographs, resulting in a delayed diagnosis. OBJECTIVE: To assess the utility of special radiological signs in the neonatal population for the early recognition of pneumothorax. METHODS: A case-control study was conducted at a level III referral center from January 2006 to December 2012. For each neonate with pneumothorax, one infant was selected for the control group. A senior radiologist and neonatologist experienced in reading chest radiographs evaluated each radiograph for the presence of special radiological signs. RESULTS: Of the 1,375 infants admitted to the NICU during the study period, 39 had a pneumothorax. A total of 223 radiographs were scored and 46% of the neonates were found to have occult pneumothoraces before they were clinically diagnosed. Twenty-six percent had a single sign detected on a radiograph, whereas 20% had multiple signs. The time interval between the appearance of these signs and clinical diagnosis ranged between 0.5 and 27 h. CONCLUSIONS: The present study shows that the recognition of these signs would assist the physician in identifying occult pneumothorax earlier in its course. Physicians dealing with critically ill infants should ensure that they can recognize these radiological signs.