Original Research
Can neonatal pneumothorax be successfully managed in regional Australia?
AUTHORS
Andrew Shen1 BSc, MBBS, Resident Medical Officer *
Jerry Yang2 MBBS, Resident Medical Offcer
Gwenda Chapman3 BSc (Hons), Graduate Certificate in Biostatistics, Research Assistant
Sunday Pam4 MBBS, MSc Mother and Child Health, MRCPCH, FRACP, FWACP, Staff Specialist, Chair of Human Research Ethics Committee at Central Queensland Hospital and Health Service
AFFILIATIONS
1 Rural Clinical School, School of Medicine, University of Queensland, Canning St, Rockhampton, Qld 4700, Australia. Present address: Obstetrics and Gynaecology, Redcliffe Hospital, Queensland Health, Brisbane, Qld 4020, Australia
2 Sunshine Coast University Hospital, Queensland Health, 6 Doherty St, Birtinya, Qld 4575, Australia
3 Rural Clinical School, School of Medicine, University of Queensland, Canning St, Rockhampton, Qld 4700, Australia
4 Paediatrics, Rockhampton Hospital, Queensland Health, Canning St, Rockhampton, Qld 4700, Australia
ACCEPTED: 10 June 2020
early abstract:
Objectives: To describe the outcomes of neonatal pneumothorax in regional Australia.
Methods: A retrospective observational study of all neonates born between 01/01/2008 and 31/12/2015 coded by hospital records with a diagnosis of neonatal pneumothorax in Central Queensland (CQ). Data for gender and birth gestation for all CQ births of the same period was also obtained. Descriptive statistics were calculated for birth weight and gestation, and Apgar scores. Frequencies were calculated for gender, length of admission, age of diagnosis and risk factors including meconium aspiration syndrome (MAS), prolonged rupture of membranes (PROM) and positive pressure ventilation (PPV). The primary outcome measure was successful treatment at a CQ hospital versus requirement for transfer to tertiary hospital or death prior to transfer. Statistical significance was calculated for binary and continuous variables.
Results: During the study period, there were 31 cases of pneumothorax amongst 17640 deliveries recorded by 3 CQ hospitals, with a significant bias towards males (84%) amongst pneumothorax cases (p < 0.001). Median gestational age was comparable between the CQ population and the pneumothorax cohort. Diagnosis of pneumothorax was usually made within 48 hours of birth (87.1%). PPV was present in two thirds whilst MAS and PROM were less common. No significant relationship was found between type of pneumothorax and gender, birth weight, MAS, PROM, caesarean section or PPV. The majority of cases were successfully treated locally (67.7%) and with oxygen alone (64.5%). Other treatment modalities included surfactant use, thoracocentesis, chest tube insertion and PPV. Patients with bilateral pneumothorax or pneumomediastinum had poorer outcomes (p = 0.04). Overall local outcomes were good with only 1 perinatal death prior to discharge or transfer.
Conclusion: Neonatal pneumothorax is effectively managed in the regional hospitals studied in keeping with contributions of regional Paediatricians and Rural Generalists . Compared with unilateral pneumothorax, bilateral pneumothorax or pneumomediastinum was associated with transfer to tertiary centre. There were no clear predictors for bilateral pneumothorax.