Neonatal pneumothorax in congenital diaphragmatic hernia: Be wary of high ventilatory pressures

BackgroundPatients with congenital diaphragmatic hernia (CDH) require invasive respiratory support and higher ventilator pressures may be associated with barotrauma. We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair.MethodsWe retrospectively reviewed...

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Bibliographic Details
Published in:World journal of pediatric surgery 2022-05, Vol.5 (3), p.e000341-e000341
Main Authors: Rubalcava, Nathan, Norwitz, Gabriella A, Kim, Aimee G, Weiner, Gary, Matusko, Niki, Arnold, Meghan A, Mychaliska, George B, Perrone, Erin E
Format: Article
Language:English
Subjects:
Apgar score
Birth weight
Defects
Extracorporeal membrane oxygenation
Gestational age
Hernias
intensive care, neonatal
Mortality
Original Research
Patients
pediatrics
Pneumothorax
Regression analysis
Risk factors
thoracic surgery
Ultrasonic imaging
Ventilators
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Summary:BackgroundPatients with congenital diaphragmatic hernia (CDH) require invasive respiratory support and higher ventilator pressures may be associated with barotrauma. We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair.MethodsWe retrospectively reviewed newborns born with CDH between 2014 and 2019 who developed a pneumothorax, and we matched these cases to patients with CDH without pneumothorax.ResultsTwenty-six patients were included (n=13 per group). The pneumothorax group required extracorporeal life support (ECLS) more frequently (85% vs 54%, p=0.04), particularly among type A/B defects (31% vs 7%, p=0.01). The pneumothorax group had higher positive end-expiratory pressure (PEEP) within 1 hour of birth (p=0.02), at pneumothorax diagnosis (p=0.003), and at ECLS (p=0.02). The pneumothorax group had a higher mean airway pressure (Paw) at birth (p=0.01), within 1 hour of birth (p=0.01), and at pneumothorax diagnosis (p=0.04). Using multiple logistic regression with cluster robust SEs, higher Paw (OR 2.2, 95% CI 1.08 to 3.72, p=0.03) and PEEP (OR 1.8, 95% CI 1.15 to 3.14, p=0.007) were associated with an increased risk of developing pneumothorax. There was no difference in survival (p=0.09).ConclusionsDevelopment of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP. A pneumothorax increases the likelihood of treated with ECLS, even with smaller defect.
ISSN:2516-5410
2096-6938
2516-5410
DOI:10.1136/wjps-2021-000341