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Decreased heart sound in a healthy newborn: Spontaneous multiseptated cystic pneumomediastinum with delayed respiratory distress

Korean Journal of Pediatrics 2010;53(2):244-247.
Published online February 15, 2010.
Decreased heart sound in a healthy newborn: Spontaneous multiseptated cystic pneumomediastinum with delayed respiratory distress
Young June Choe1, Eun eun Kim1, Ee-Kyung Kim1, Han-Suk Kim1, Jung-Eun Chun2, Woo Sun Kim2, In-One Kim2, Jung-Hwan Choi1
1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
2Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
자발성 종격동 기흉: 작게 청진된 심음을 주소로 내원한 신생아
최영준1, 김은선1, 김이경1, 김한석1, 천정은2, 김우선2, 김인원2, 최중환1
1서울대학교 의과대학 소아과학교실
2서울대학교 의과대학 영상의학교실
Correspondence: 
Ee-Kyung Kim, Tel: +82.2-2072-3628, Fax: +82.2-2072-0590, Email: kimek@snu.ac.kr
Abstract
Spontaneous pneumomediastinum in the absence of predisposing risk factors has been rarely observed in full-term neonates. A 3-day-old neonate, delivered vaginally at term without any perinatal complications or signs of respiratory difficulty, was referred to the Seoul National University Children’s Hospital because of reduced heart sound detected during routine neonatal examination. Chest computed tomography (CT) showed air collection in the anterior mediastinum. The baby developed respiratory distress on the fourth day and required supplemental oxygen. On the seventh day, there was no sign of respiratory difficulty, and x-ray examination showed no demonstrable pneumomediastinum. Hence, careful neonatal physical examination is essential during the postnatal assessment of newborns, and spontaneous pneumomediastinum should be considered when a healthy newborn presents with reduced heart sound.
Key Words: Spontaneous pneumomediastinum, Term infant, Chest auscultation


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