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Secondary Pneumothorax in the newborn.

Journal of the Korean Pediatric Society 1985;28(2):123-130.
Published online February 28, 1985.
Secondary Pneumothorax in the newborn.
Dong Gwan Han
Department of Pediatrics, Yonsei University, College of Medicine, Seoul,Korea
新生兒 肺外空氣渴出 II(三次性氣胸의 臨床的 考察)
韓東觀
延世醫大 小兒科學敎室
Abstract
Clinical records of 25 neonates with secondary pneumothorax were reviewed retrospectively during last 6 years from Jan. 1978 through Dec. 1983 at Pediatric Department of Yonsei University Hospital. The following results were obtained; 1)The incidence of secondary pneumothorax was 0.16% (21 out of 12,864 live-birth) during the neonatal period. The incidence tended to increase since we had set up the neonatal, intensive care unit. 2)There were many prenatal and postnatal complications as wall as underlying diseases; the prematurity (40.0%), low-birth weight(48.0%), severe neonatal asphyxia (56.0%), hyaline membrane disease (40.0%), moconium aspiration syndrome (20.0%), congenital heart or anomalies (20.0%) and etc. 3)The pneumothorax was more frequent in right side(right 60.0%, loft 24.0%, bilateral. 16.0%), 16.0% had an associated pulmonary interstitial emphysema and 8.0% pnoumomedia-stinum. Tension pneumothorax occurred in 84.0%. 56.0% occurred within 24 hours after birth. The symptoms and signs were cyanosis, bradycardia, chest retraction, tachycardia, decreased breath sound on the affected side and apnea in order of frequency. 4) Mortality was high representing 68.0%, which was thought to be associated with high in-cidence of prematurity, low-birth weight, severe neonatal asphyxia, hyaline membrane disease and congenital anomalies. The mortality rate in the group treated by vinca needle drainage was 88.7%, while the others drained by chest tube with continuous suction was 25.0%. Comparing with spontaneous pneumothorax, the incidence of secondary pneumothorax was 5 times higher than that of spontaneous pneumothorax, while the death rate was 3 times higher. And the others were more frequent in the secondary pneumothorax, such as prenatal complications, neonatal asphyxia, prematurity, low-birth weight, hyaline membrane disease and septicemia.
Key Words: Pneumothorax, Pneumomediastinum and pulmonary interstitial emphysema in the newborn, HMD, MAS, Neonatal resuscitation, mechanical ventilation


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