Events before the diagnosis of a pneumothorax in ventilated neonates.
OBJECTIVE
To examine the relation of overventilation and other clinical events to the development of pneumothoraces in ventilated neonates.


METHODS
A case-control study.


RESULTS
Fifty three (8.7%) of 606 ventilated neonates developed a pneumothorax. Eighteen (34%) cases and 23 (43%) controls were unintentionally overventilated (PaCO(2) < 4 kPa) at some time before the pneumothorax developed in the cases (odds ratio (OR) = 0.78, 95% confidence interval (CI) 0.48 to 1.27). In the three hours before the diagnosis of pneumothorax, more cases than controls were reintubated (21/53 v 4/53; OR = 5.25, 95% CI 1.9 to 14.3), and also in seven cases (one control) the mean airway pressure was increased, whereas in nine controls (no cases) it was reduced (chi(2) = 12.0, df = 2, p = 0.001). Seven of 18 neonates diagnosed by transillumination had undergone no clinical procedures before diagnosis compared with five of 35 diagnosed radiologically (OR = 2.7, 95% CI 1.0 to 7.4).


CONCLUSIONS
Unintentional overventilation was not associated with pneumothoraces. In the hours before diagnosis, there was increased clinical intervention, including reintubation; this was less so in those diagnosed by transillumination. The study did not elucidate whether such interventions caused the pneumothorax or were secondary to a failure to diagnose it.
Watkinson
M
M
Neonatal Unit, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK. watkinm@heartsol.wmids.nhs.uk
Tiron
I
I
D016022:Case-Control Studies; D016001:Confidence Intervals; D006801:Humans; D016857:Hypocapnia / Q000209:etiology; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000209:etiology*; D007442:Intubation, Intratracheal / Q000009:adverse effects; D016017:Odds Ratio; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology*; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D014172:Transillumination