PT  - JOURNAL ARTICLE
AU  - Ikhwan Halibullah
AU  - Fiona Hammond
AU  - Kate Hodgson
AU  - Natalie Duffy
AU  - Michael Stewart
AU  - Arun Sett
TI  - Management of pneumothorax in neonatal retrieval: a retrospective cohort study
AID  - 10.1136/archdischild-2022-324352
DP  - 2022 Sep 27
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - fetalneonatal-2022-324352
4099  - http://fn.bmj.com/content/early/2022/09/27/archdischild-2022-324352.short
4100  - http://fn.bmj.com/content/early/2022/09/27/archdischild-2022-324352.full
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information.