Predictors and Outcomes of Pneumothorax in Premature Neonates

Abstract

Background:

Pneumothorax rates are highest among preterm neonates with respiratory distress syndrome. There is limited information about risk factors and outcomes in this population.

Methods:

This is a retrospective case-control study. Cases were neonates <32 weeks born from 2014-2015 with respiratory distress syndrome and pneumothorax in the first 7 days of life. They were identified through searching the quality database of the Sharp Mary Birch Hospital for Women and Newborns. Controls were those with birth times closest in chronology of the cases and gestational age within 3 days of life. Case control ratio was 1:2. Maternal and neonatal risk factors for pneumothorax identified from the literature or determined a priori to be clinically significant were extracted from the database and compared with univariate and multivariable analysis. Neonatal outcomes were also extracted and their association with pneumothorax compared with univariate and multivariable logistic regression with a threshold of P < 0.05. Infants with major congenital anomalies were excluded. The Sharp Institutional Review Board approved the secondary data analysis.

Results:

There are 25 cases and 50 controls. Gestational age, birth weight, Apgar scores, delivery room interventions, and initial mode of ventilation in the NICU were not significantly different for each group (Table 1). No cases received CPR in the delivery room. Pneumothorax was significantly associated with maternal bleeding (OR 3. 4; 95% CI 1.10-10.17; P=.034), intubated in the first 7 d (OR 12.36; 95% CI 1.54-99. 38; P=.018), and multiple doses of surfactant (OR 4. 75; 95% CI 1.70-13. 31; P=.003). Outcomes of Severe IVH (OR 12.25; 95% CI 1.35-111.51; P=.026), and Death/Severe IVH (OR 11.29; 95% CI 2.18-58.53; P=.004), were significantly associated with pneumothorax.

Conclusions:

Obstetrical bleeding, intubated in the first 7 days of life, and 2 or more doses of surfactant were significantly associated with pneumothorax. Subjects with pneumothorax had a significantly higher risk of Severe IVH and the combined outcome of Death/Severe IVH.

Disclosures:

None.

Table 1 Maternal & Infant Risk Factors, Neonatal Outcomes, Pneumothorax Compared to Control *P <.05