Article Text

Download PDFPDF
Management of pneumothorax in neonatal retrieval: a retrospective cohort study
  1. Ikhwan Halibullah1,2,
  2. Fiona Hammond1,
  3. Kate Hodgson1,2,3,4,
  4. Natalie Duffy1,5,
  5. Michael Stewart1,5,6,
  6. Arun Sett1,3,4,5
  1. 1 Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  2. 2 Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia
  3. 3 Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia
  4. 4 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Melbourne, Australia
  5. 5 Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  6. 6 Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Australia
  1. Correspondence to Dr Ikhwan Halibullah, Paediatric, Infant and Perinatal Emergency Retrieval, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; ikhwan.halibullah{at}rch.org.au

Abstract

Background Management of pneumothorax in neonates requiring retrieval poses unique challenges, including decision to insert an intercostal catheter (ICC). We aimed to report the proportion and characteristics of neonates transported with and without ICC insertion and the incidence of deterioration in neonates transported with pneumothorax.

Methods A retrospective cohort study of neonates transported with pneumothorax between 2016 and 2020 in Victoria, Australia. Univariate analysis was performed on patient and clinical characteristics, followed by multivariate analysis to identify risks independently associated with ICC insertion.

Results 174 neonates were included. Mean (SD) gestational age (GA) was 37.5 (2.8) weeks. Eighty-two neonates (47%) had ICC inserted. On multivariate analysis, risk factors independently associated with ICC insertion were mechanical ventilation (MV) preceding retrieval team arrival (OR 12, 95% CI 3.1 to 46.6, p<0.001) and radiographical mediastinal shift (MS) (OR 6.2, 95% CI 2.4 to 16.2, p<0.001). Increasing GA is negatively associated with ICC insertion (OR 0.66, 95% CI 0.5 to 0.8, p<0.001). No significant difference in incidence of deterioration between the ICC group and the no-ICC group was observed (8.5% vs 5.4%, p=0.55). Ninety-five neonates were treated with needle aspiration (NA); 40 (42%) subsequently avoided ICC insertion. Twelve (13%) neonates transported without ICC had insertion within 24 hours following transport.

Conclusion Many neonates with pneumothorax are transported without ICC, with low incidence of deterioration and ICC insertion within 24 hours after transport. More than a third of neonates managed with NA avoided ICC insertion. The likelihood of ICC insertion is increased by lower GA, MV prior to retrieval team arrival and radiographical MS.

  • Neonatology
  • Intensive Care Units, Neonatal
  • Emergency Care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text

Footnotes

  • Contributors IH, KH, ND, MS and AS conceived and designed the study. IH and FH conducted data collection, analysis and interpretation. IH drafted the manuscript and was responsible for the overall content as guarantor. AS and KH supervised the project. All authors critically reviewed the manuscript, provided the final approval for the final version to be published and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.