Factors Associated with Pneumothorax in Premature Neonates of Interior Sindh

Abstract

Background: Pneumothorax is a life-threatening condition varying from 10% in low-birth-weight premature neonates to 1% in full-term neonates. A few risk factors are associated with pneumothorax, including gender, maturity level at birth, birth weight, persistent membrane rupture for more than 24 hours, and development of respiratory distress syndrome. Early recognition and timely management are essential to avoid complications and mortality. Objective: To determine the frequency of pneumothorax in preterm neonates and the associated factors in a tertiary care hospital in interior Sindh. Methodology: A case-control study was conducted at the pediatric department of Maternity and Child Health Care Center Institute, Nawabshah, from November 2020 to December 2021. For the suspected diagnosis of pneumothorax cases, clinical indicators including respiratory distress, cyanosis, and increased oxygen demand were used. For the confirmation of the suspected diagnosis, a chest X-ray was done. The confirmed cases of pneumothorax and the control group were further investigated for the possible association of risk factors including gestational age, gender, birth weight, head circumference, APGAR score at 1st and 5th minutes of life, maternal age, antenatal steroid therapy, and mode of delivery. The data was analyzed using SPSS version 20. Results: The mean gestational age of study participants was 32.4 ± 3.2 weeks in the pneumothorax group, while 35.1 ± 2.4 in the non-pneumothorax group. The maternal age in pneumothorax cases was 33.2 ± 2.4 years, while in control it was 29.9 ± 1.7 years. The birth weight in non-pneumothorax control (975 ± 253 g) was a little more than the cases (897 ± 172 gm), but the association was non-significant. In the control group, the majority of the participants (57.4%) were moderately preterm, i.e., between 32 weeks and 35 weeks, while 55.6% of cases of pneumothorax were early preterm (28-31 weeks), and the association was strongly significant (p-value ≤0.05). Conclusion: It can be concluded that the mortality rate of 46% with neonatal pneumothorax highlights the severity of the disease and the need for close monitoring of neonates and prevention before its occurrence. The risk factors like gestational age (preterm) and antenatal steroids reported a strong, significant association and respiratory distress syndrome was the most common cause of neonatal pneumothorax.