150 - Comparison of chest tube drainage vs needle aspiration for primary treatment of neonatal pneumothorax.
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 150 Publication Number: 150.437
Laurie Guzman, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, ny, NY, United States; Nicole T. Spillane, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States; Sabrina Malik, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, Hackensack, NJ, United States; Tara Lozy, Hackensack Meridian School of Medicine, Hackensack, NJ, United States
Fellow Joseph M. Sanzari Children's Hospital Hackensack University Medical Center ny, New York, United States
Background: Pneumothorax (PTX) is a potentially life threatening emergency that can occur during the neonatal period. PTX may occur spontaneously or due to underlying pulmonary disease and/or provision of respiratory support. The incidence of PTX in the neonate has been reported to be 6% in preterm neonates and 1-2% in term neonates. Chest tube drainage (CTD) and needle aspiration (NA) are the two treatment modalities. Although CTD is considered the gold standard treatment, it is more invasive than NA. There is limited data comparing the two treatments in neonates. Objective: The aim of our study is to compare the efficacy and safety of CTD vs NA in the treatment of neonatal PTX. Design/Methods: This is a single center retrospective study of inborn neonates with PTX at a Level 3 NICU between January 2017 and June 2019. PTX was defined by the accumulation of air in the pleural space on chest radiograph as interpreted by a radiologist. The size of the PTX was determined by the degree of collapse. Collapse of 20% or less was defined as small, 21%-39% was moderate and greater than 40% was large. Analysis of Variance (ANOVA) and chi-square test were used to assess significant differences dependent upon the variable type with a significance threshold of 0.05. Results: 105 infants with median GA of 37 weeks and median BW of 2.915 kg were included. There was an association between gestational age and type of management (p< 0.01) (Table 1). Twenty (19%) were treated with CTD alone, 57 (54%) were treated with expectant management (EM), 10 were treated with NA alone, and 18 were treated with a combination of NA and CTD. Overall, 35.7% of PTX were treated successfully with NA alone (Table 2). CTD had a significantly better success rate compared to NA (p < 0.001). There was no association with CTD and NA and size of PTX (p=0.59). None of the patients that required subsequent CTD after NA experienced a hemodynamic adverse event. The median length of stay (LOS) for infants ≥ 34 weeks GA with a successful primary intervention was 9 days for CTD, 4 days for EM and 2 days for NA (Figure 1).
Conclusion(s): In this small retrospective study, 35.7% of PTX that required an intervention were successfully treated with NA alone. Infants who failed NA did not experience complications related to delay in CTD. Based on this preliminary data, NA appears to be a safe primary intervention which may avoid more invasive chest tube drainage in some patients. Clinicians should be aware that approximately ⅔ of infants initially treated with NA will require a second intervention.
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