Study of Treatment Modalities for Neonatal Pneumothorax in rural tertiary care hospital
Abstract
Introduction: Neonatal pneumothorax, characterized by the accumulation of air in the pleural cavity, is a critical condition observed in up to 9.2% of neonates in neonatal intensive care units (NICUs). It poses risks such as respiratory distress, hemodynamic compromise, intraventricular hemorrhage, and increased mortality. Management strategies include conservative observation, needle aspiration (NA), and intercostal catheter (ICC) insertion, tailored to clinical severity, radiographic findings, and available resources. This study evaluates treatment modalities for neonatal pneumothorax in a rural tertiary care hospital.
Methods: A descriptive longitudinal observational study was conducted from December 2020 to December 2022 at Dr. Balasaheb Vikhe Patil Rural Medical College, Loni. The study included 60 neonates diagnosed with pneumothorax in inborn and outborn NICUs. Exclusion criteria included neonates with major congenital malformations. Data collection encompassed clinical history, diagnostic findings, and management approaches, including observation, CPAP,NA, ICC placement. Statistical analysis evaluated treatment outcomes based on the pneumothorax's side (unilateral or bilateral) and severity.
Results: Out of 60 cases, 48.3% had right-sided pneumothorax, 28.3% left-sided, and 23.3% bilateral. CPAP was used in 61.7% of cases, particularly in less severe presentations. Ventilator support was required in 73.3%, with a significantly higher demand among outborn neonates (p=0.03). Needle aspiration was performed in 31.7% of cases, with higher use in left-sided pneumothorax (57%). Chest tube insertion was necessary in 75% of cases, predominantly for right-sided (79.3%) and bilateral pneumothorax (78.5%).
Discussion: The findings align with global studies, highlighting a higher incidence of right-sided pneumothorax due to anatomical predisposition. The study underscores the effectiveness of CPAP in mild cases and the necessity of ICC insertion in severe or bilateral cases. The outcomes advocate for individualized treatment strategies based on clinical severity and resource availability.
Conclusion: Neonatal pneumothorax remains a significant NICU challenge, necessitating prompt diagnosis and tailored interventions. Advances in non-invasive respiratory support and judicious use of mechanical ventilation can mitigate risks. Further research on minimally invasive techniques and long-term outcomes is crucial to optimizing neonatal care and improving survival and neurodevelopmental follow-up.
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