Pneumothorax - infants

• Alternative Names

  Air leak syndrome

• Causes, incidence, and risk factors

  A pneumothorax occurs when the tiny air sacs (alveoli) in a baby’s lung burst, leaking air into the space between the lung and chest wall (pleural space).

  The most common cause of pneumothorax is respiratory distress syndrome, which occurs in babies who are born too early (premature).

  • Because the baby's lungs lack a slippery substance (surfactant), the tiny air sacs are not able to expand as easily.
  • If the baby is put on a breathing machine (mechanical ventilator), there is extra pressure on the baby's lungs, which can sometimes burst the air sacs.

  Meconium aspiration syndrome is another cause of pneumothorax in newborns. As the baby is being born, he or she may breathe in the first bowel movement, called meconium. This may cause breathing problems and the need for a breathing machine.

  Less commonly, an otherwise healthy baby can develop an air leak when he or she takes the first few breaths after birth. This occurs because of the pressure needed to expand the lungs for the first time.

  Pneumothorax is more common in boys than girls.

• Symptoms

  Many infants with pneumothorax do not have symptoms. When symptoms do occur, they can include:

  • Bluish skin color (cyanosis)
  • Fast breathing
  • Flaring of the nostrils
  • Grunting with breathing
  • Irritability
  • Restlessness
  • Use of other chest and abdominal muscles to aid breathing (retractions)
• Signs and tests

  The nurses and doctors may have difficulty hearing breath sounds when listening to the infant’s lungs with a stethoscope. The heart or lung sounds may seem as if they are coming from a different part of the chest than normal.

  Tests for pneumothorax include:

  • Chest x-ray
  • Light probe placed against the baby’s chest, also known as "transillumination" (pockets of air will show up as lighter areas)
• Treatment

  Babies without symptoms may not need treatment. The health care team will monitor your baby’s breathing, heart rate, and color.

  If your baby is having symptoms, the doctor will place a needle or thin tube called a catheter into the baby’s chest to remove the air that has leaked into the chest space.

  Treatment can last for a few days to a few weeks.

• Expectations (prognosis)

  Some air leaks will go away on their own within a few days without treatment. Infants who are treated by removing the air with a needle or catheter usually do well after treatment.

• Complications

  Although babies on breathing machines are carefully watched, air leaks can occur.

  As air builds up in the chest, it can push the heart toward the other side of the chest. This puts pressure on both the lung that hasn’t collapsed and the heart. This condition is called tension pneumothorax. It is a medical emergency.

• Calling your health care provider

  Often pneumothorax is discovered shortly after the baby is born. Call your health care provider if your infant has symptoms of pneumothorax.

• Prevention

  The health care providers in the newborn intensive care unit (NICU) should watch your infant carefully for signs of an air leak.

• References

  Dudell GG, Stoll BJ. Respiratory tract disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 101.

  Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician, 2007;76:987-994.

Review Date: 1/28/2010

Reviewed By: Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.