What is pneumothorax?
Pneumothorax is a condition in which air in the lungs leaks into the chest cavity.
Pneumothorax is one type of a group of lung disorders called air leak syndrome. A
baby can have more than one form of air leak. Other types of air leaks include the
Pneumomediastinum. Air leaks into the mediastinum. This is the space in the thoracic cavity behind the
sternum and between the two pleural sacs containing the lungs.
Pneumopericardium. Air leaks into the sac surrounding the heart.
Pulmonary interstitial emphysema (PIE). Air leaks out of the alveoli, the tiny air sacs of the lungs.
Air leaks may come on suddenly or may develop slowly. The degree of illness depends
on the location of the leak, how quickly the leak occurs, and the amount of air.
What causes pneumothorax?
The pressure of the air delivered by breathing machines (mechanical ventilators) is
the most common cause. Inhalation of the first stools passed while the baby is still
in the mother’s uterus (meconium aspiration) can also trap air. This can lead to the
lungs expanding too much and to air leaks. Air leaks often occur in the first 24 to
36 hours after birth. Some otherwise healthy babies can develop a spontaneous air
leak that does not cause symptoms or distress.
Who is affected by pneumothorax and air leak syndrome?
Babies most at risk for pneumothorax are:
Babies with other lung diseases such as respiratory distress syndrome (RDS), also
known as hyaline membrane disease (HMD)
Babies on mechanical ventilators
Premature babies whose lung tissues are more fragile
Babies with meconium aspiration, because the meconium plugs the airways, causing areas
of the lungs to collapse
What are the symptoms of pneumothorax and other air leaks?
The following are the most common signs and symptoms of pneumothorax. However, each
baby may experience symptoms differently. Symptoms may include:
Increasing respiratory distress, including rapid breathing, grunting, nostril flaring,
and chest wall retractions
Trouble hearing or abnormal breath sounds when listening with a stethoscope
Changes in arterial blood gas levels
The signs and symptoms of pneumothorax may resemble other conditions or health problems.
Always consult your baby's healthcare provider for a diagnosis.
How are pneumothorax and other air leaks diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures
for pneumothorax may include:
Chest X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images
of internal tissues, bones, and organs onto film. X-rays may show the following:
Transillumination. A fiber optic light probe placed on the baby's chest wall (the side of the chest with
the air leak transmits brighter light). This procedure is often used in an emergency.
Ultrasound. Sound waves are used to determine if the lung surface is touching the inner chest
Treatment for pneumothorax and other air leaks
Your baby’s healthcare provider will figure out the best treatment plan for your baby
Your baby's gestational age, overall health, and medical history
How sick your baby is
How well your baby handles certain medicines, treatments, or therapies
If your baby’s condition is expected to get worse
The opinion of the healthcare providers involved in your child's care
Your opinion or preference
Treatment for pneumothorax may include:
Spontaneous air leaks that do not cause symptoms or distress may get better on their
own without treatment. As the leak seals over, air is absorbed into the body.
There are no specific treatments for pneumomediastinum and pulmonary interstitial
emphysema (PIE). That’s because these air leaks are in spaces that can’t be treated
with chest tubes. High frequency ventilation, a special kind of mechanical ventilation, is
sometimes used for babies with PIE.
Prevention of pneumothorax and other air leaks
Despite careful regulation of the air pressure and the settings on mechanical ventilators,
air leaks can still occur. Your baby's healthcare provider and other providers in
the newborn intensive care unit (NICU) will watch your baby carefully for signs of
air leak so that treatment can be started as quickly as possible.