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Clinical feature of neonatal pneumothorax induced by respiratory distress syndrome and pneumonia

Korean Journal of Pediatrics 2009;52(3):310-314.
Published online March 15, 2009.
Clinical feature of neonatal pneumothorax induced by respiratory distress syndrome and pneumonia
Ji-Sun Jung, Sang-Woo Park, Chun-Soo Kim, Sang-Lak Lee, Tae-Chan Kwon
Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
호흡곤란증후군과 폐렴에 의한 신생아 기흉의 임상적 특성
정지선, 박상우, 김천수, 이상락, 권태찬
계명대학교 의과대학 소아과학교실
Correspondence: 
Sang-Lak Lee, Email: lsl@dsmc.or.kr
Abstract
Purpose
: Pneumothorax is an important factor responsible for increased mortality and morbidity in neonates. Here, we compared the clinical findings and prognosis for neonatal pneumothorax induced by respiratory distress syndrome (RDS) and pneumonia.
Methods
: Between January 2001 and December 2005, 80 patients with neonatal pneumothorax induced by RDS and pneumonia and admitted to the NICU of Dongsan Medical Center, Keimyung University, were enrolled. They were assigned to the RDS group (30 cases) or the pneumonia group (50 cases). Admission records for gestational age, onset day of life, rate of ventilatory care and thoracostomy, and prognosis were retrospectively reviewed and statistically analyzed for both groups.
Results
: The mean gestation age was significantly shorter in the RDS group (32.3 weeks) than in the pneumonia group (38.1 weeks) (P<0.001), and the mean onset day of life were later in the RDS group (4.6 days) than in the pneumonia group (1.8 days) (P<0.05). Rates of ventilatory care and thoracostomy were higher for the RDS group than for the pneumonia group (100% vs. 44%, and 66.7% vs. 48%, respectively). Total mortality rates and pneumothorax specific mortality rates were higher for the RDS group than for the pneumonia group (46.7% vs. 18%, P<0.01 and 33.3% vs. 16%, P<0.05, respectively). After logistic regression analysis, preterm significantly increased the mortality rate (OR 7.44, 95% CI: 1.99-27.86, P<0.005), but bilateral involvement (OR 1.17, 95% CI: 0.82-1.67, P>0.5) and the RDS group itself (OR 1.70, 95% CI: 0.52-5.54, P>0.3) did not increase mortality rates significantly.
Conclusion
: Our study suggests that neonatal pneumothorax in the RDS group tends to have a later onset, higher mortality rate, and needs a higher rate of thoracostomy than the pneumonia group. However, after logistic analysis, only preterm significantly and independently increased the mortality rate.
Key Words: Newborn, Pneumothorax, Respiratory distress syndrome, Pneumonia


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