Pneumothorax (collapsed lung) is a condition that involves air leaking out of the lung. The air collects in the space between the lining of the lung and the lining of the chest. When air accumulates in this space, it causes the pressure outside of the lung to be greater than the pressure inside of the lung. This leads to partial or total collapse of the lung. Whether the collapse is partial or total depends on how much of the lung collapses.
Pneumothorax is most common in newborns out of any age group. It often occurs in newborns who are born with a respiratory disorder or trouble breathing, although it can occur without any apparent cause. Premature newborns or late term newborns with meconium aspiration syndrome are especially susceptible to pneumothorax.
Common symptoms of pneumothorax in the newborn include:
Many newborns exhibit no sign of pneumothorax.
Pneumothorax in newborns is typically caused by an underlying respiratory condition, preterm birth, or aspiration of meconium. Infants born too early have not developed a coating known as a surfactant on the air sacs that sit at the bottom of the lungs. Surfactant helps keep the lungs inflated during the act of breathing. Additionally, many premature babies develop respiratory conditions that make them more likely to experience a collapsed lung.
In contrast, many newborns who are born past their due date run the risk of aspirating meconium, the first faeces that a newborn passes.
Meconium is usually passed shortly after birth, but when a baby is overdue, they may pass meconium while still in the womb. This can be accidentally inhaled with amniotic fluid during a vaginal delivery, leading to collapse of a lung.
The risk factors for pneumothorax in a newborn are premature birth, respiratory distress syndrome, and oxygen therapy that is improperly administered. Some newborns need mechanical ventilation to help them start breathing. It is possible to push too much air into the lungs when assisting a newborn with the work of breathing and cause an air leak.
Newborns often show no symptoms of a pneumothorax, and unlike in adult pneumothorax, there are no obvious causes of lung collapse right away. A physician may suspect pneumothorax if the newborn has respiratory distress syndrome, is premature, or has abnormal sounds of breathing on one side of the chest. To confirm a diagnosis of pneumothorax in an infant, a chest X-ray will be done.
One potential complication of pneumothorax in an infant is tension pneumothorax. A pneumothorax develops into a tension pneumothorax when the air that has collected in the space between the collapsed lung and the wall of the chest pushes the heart and the other lung off-centre. This is rare and can be life-threatening.
Treatment for pneumothorax in newborns includes oxygen therapy to help them breathe until they can comfortably breathe on their own again and possibly removing some of the air from their chest cavity. Air can be removed from the chest cavity using a syringe and a needle. In more severe cases, a tube may be placed to continually remove air over the course of several days.
Newborns with no symptoms require no treatment, only close monitoring.