Predictors of chest drainage of pneumothorax in neonates

Tan, Ya-lan; Zhan, Yang; Geng, Jia; Chen, Wei; Guo, Wan-Liang

doi:10.1590/1414-431X20209469

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Brazilian Journal of Medical and Biological Research

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Research Article • Braz. J. Med. Biol. Res. 53 (8) • 2020 • https://doi.org/10.1590/1414-431X20209469 copy

Predictors of chest drainage of pneumothorax in neonates

Authorship SCIMAGO INSTITUTIONS RANKINGS

This is a retrospective, single-center observational study to explore the predictors of chest drainage for neonatal pneumothorax. A total of 183 neonates (age ≤28 days) who presented to the Children's Hospital of Soochow University between January 1, 2015 and December 31, 2018 for pneumothorax or developed pneumothorax during a hospital stay were included. Demographic data, clinical presentation, and imaging characteristics of neonatal pneumothorax were collected and analyzed. We used univariate and multivariate logistic regression analyses to determine significant predictors of chest drainage of pneumothorax in neonates. Pneumothorax occurred within 24 h after birth in 131 (71.6%) cases, between 24 and 48 h after birth in 41 (22.4%) cases, and 48 h after birth in 11 (6.0%) cases. Univariate and multivariate logistic regression analyses revealed that lung collapse ≥1/3 on initial chest X-ray (OR 4.99, 95%CI 2.25-11.07), chest retractions (OR 8.12, 95%CI 2.88-22.89), cyanosis (OR 2.25, 95%CI 1.08-4.66), and frothing from mouth (OR 2.49, 95%CI 1.12-5.49) (P<0.05 for all) were significant predictors of the need for chest drainage due to pneumothorax. In conclusion, the thorough evaluation of the above predictive factors can guide treatment and improve patient outcome.

Neonate; Pneumothorax; Chest drainage; Predictor

Variables	n (%)
Demographic data
Gender, male	114 (62.3)
Gestational age,<37 weeks	72 (39.3)
Birth weight, <2500 g	44 (24.0)
Perinatal data
C-section	122 (66.7)
Meconium-stained amniotic fluid	41 (22.4)
Nuchal cord	16 (8.7)
Placental abruption	12 (6.6)
Perinatal asphyxia and resuscitation	38 (20.8)
Neonatal data
Meconium aspiration syndrome	11 (6.0)
Respiratory distress syndrome	31 (16.9)
Pneumonia	141 (77.1)
Congenital heart disease	29 (15.8)
Mechanical ventilation before pneumothorax	92 (50.3)
Mortality	2 (1.1)

	Drainage (n=76)	No drainage (n=107)	P
Demographic data
Gender, male	27 (35.5)	42 (39.3)	0.6083^a
Gestational age, <37 weeks	36 (47.4)	36 (33.6)	0.0611^a
Birth weight, <2500 g	16 (21.1)	28 (26.2)	0.4249^a
Perinatal data
C-section	58 (76.3)	64 (59.8)	0.0196^a
Meconium-stained amniotic fluid	12 (15.8)	29 (27.1)	0.0705^a
Nuchal cord	5 (6.6)	11 (10.3)	0.3824^a
Placental abruption	7 (9.2)	5 (4.7)	0.3581^b
Perinatal asphyxia and resuscitation	10 (13.2)	28 (26.2)	0.0325^a
Neonatal data
Meconium aspiration syndrome	3 (3.9)	8 (7.5)	0.5002^b
Respiratory distress syndrome	15 (19.7)	16 (15.0)	0.3953^a
Pneumonia	58 (76.3)	83 (77.6)	0.8424^b
Congenital heart disease	16 (21.1)	13 (12.1)	0.1041^a
Mechanical ventilation before pneumothorax	45 (59.2)	47 (43.9)	0.0416^a
Clinical manifestations at diagnosis
Tachypnea (>60/min)	75 (98.7)	81 (75.7)	<0.0001^a
Heart rate (bpm)	140 (131-145.5)	140 (130-145)	0.4234^c
Groan	27 (35.5)	22 (20.6)	0.0243^a
Frothing from mouth	32 (42.1)	29 (27.1)	0.0339^a
Chest retractions	71 (93.4)	56 (52.3)	<0.0001^a
Enlarged hemithorax on the involved side	14 (18.4)	8 (7.5)	0.0249^a
Cyanosis	42 (55.3)	26 (24.3)	<0.0001^a
Laboratory examination at diagnosis
Leukocyte count (×10⁹/L)	16.02 (13.03-20.92)	17.44 (13.30-22.57)	0.2547^c
Neutrophil ratio (%)	75.75 (69.30-80.50)	71.5 (62.7-76.9)	0.0065^c
C-reactive protein (mg/L)	2.105 (0.645-8.135)	0.67 (0.26-2.80)	0.0002^c
First chest X-ray manifestation
Bilateral pneumothorax	11 (14.5)	14 (13.1)	0.7874^a
Lung collapse ≥1/3	41 (53.9)	21 (19.6)	<0.0001^a
Pneumomediastinum	11 (14.5)	12 (11.2)	0.5123^a

	Univariate regression			Multivariate analysis^a
	OR	95%CI	P	OR	95%CI	P
C-section	2.16	1.12-4.17	0.0209
Perinatal asphyxia and resuscitation	0.43	0.19-0.94	0.0356
Mechanical ventilation before pneumothorax	1.85	1.02-3.36	0.0425
Tachypnea (>60/min)	24.07	3.19-181.81	0.0020
Groan	2.13	1.10-4.13	0.0257
Enlarged hemithorax on the involved side	2.79	1.11-7.05	0.0294
Neutrophil ratio (%)	1.03	1.00-1.06	0.0230
C-reactive protein (mg/L)	1.05	1.01-1.10	0.0225
Chest retractions	12.93	4.84-34.56	<0.0001	8.12	2.88-22.89	<0.0001
Lung collapse ≥1/3	5.10	2.62-9.89	<0.0001	4.99	2.25-11.07	<0.0001
Frothing from mouth	1.96	1.05-3.65	0.0350	2.49	1.12-5.49	0.0245
Cyanosis	3.85	2.05-7.24	<0.0001	2.25	1.08-4.66	0.0298

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[1] Correspondence: Wan-Liang Guo: <gwlsuzhou@163.com>