| Abstract [eng] |
Background: Pneumothorax is a life-threatening neonatal condition that may cause respiratory distress and rapid deterioration of the infant’s clinical condition. Due to nonspecific clinical signs, early recognition, differential diagnosis, and identification of risk factors may be challenging. Recent literature emphasizes the importance of identifying risk factors, selecting appropriate diagnostic methods, and ensuring timely choice of invasive and non-invasive treatment in cases of neonatal pneumothorax. Aim of the study: To evaluate the perinatal and clinical characteristics, diagnostic and treatment methods, and outcomes of neonatal pneumothorax based on data from scientific literature and a retrospective analysis conducted in a single tertiary care centre in Lithuania. Objectives: To review data reported in international scientific literature on the perinatal and clinical characteristics, diagnosis, treatment methods, and outcomes of neonatal pneumothorax. To analyse demographic and clinical characteristics, diagnostic methods, radiological findings, treatment approaches, and outcomes in neonates diagnosed with pneumothorax in a single tertiary care centre, comparing term and preterm neonates. To compare the clinical data obtained from the retrospective analysis with data reported in international scientific literature. Methods: A systematic literature review was performed in the PubMed database. Seven articles were included in the analysis. In addition, a single-centre retrospective analysis of anonymized medical data was conducted at Vilnius University Hospital Santaros Klinikos. Neonates with confirmed pneumothorax between 2018 and 2024 were included in the study. Demographic and perinatal characteristics, neonatal comorbidities, diagnostic investigations, treatment methods, and outcomes were analysed. Results: The systematic literature review included 7 articles analysing 3,786 neonates diagnosed with pneumothorax. Pneumothorax most commonly occurred within the first 24 hours of life. The most frequently reported comorbidities were pneumonia (25.8%), respiratory distress syndrome (19.9%), and meconium aspiration syndrome (18.2%). Chest radiography was the main diagnostic method. According to the literature, pneumothorax was associated with a higher risk of in-hospital mortality, while invasive treatment was more frequently used in patients with a more complex clinical condition. The retrospective single-centre analysis included 96 neonates: 47 preterm and 49 term neonates. Preterm neonates were statistically significantly more likely to have jaundice, anaemia, chronic respiratory conditions, intraventricular complications, a longer duration of hospitalization, and more frequent surfactant administration. The frequency of non-invasive and invasive pneumothorax treatment did not differ significantly between term and preterm neonates. Conclusions: Based on the results of the systematic literature analysis, neonatal pneumothorax is most commonly diagnosed during the first days of life, is more common in male neonates, and often occurs together with pneumonia, respiratory distress syndrome, meconium aspiration syndrome, or other conditions associated with a more severe clinical course. The retrospective analysis conducted in a single Lithuanian tertiary care centre showed that, when comparing term and preterm neonates, preterm neonates more frequently had comorbid conditions, a longer duration of hospitalization in the neonatal intensive care unit, and more frequent surfactant administration. Both the literature analysis and the retrospective study results indicate that chest radiography was the main diagnostic method for pneumothorax. The retrospective analysis showed that the treatment of pneumothorax included conservative management, respiratory support, and invasive treatment methods; however, no statistically significant difference in the need for invasive treatment was found between term and preterm neonates. |
