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      Tension pneumothorax in a newborn after Cesarean-section delivery -A case report-

      case-report

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          Abstract

          Tension pneumothorax in newborns is a rare but life-threatening complication. We encountered a case of a full-term neonate with a breech presentation. An elective cesarean section was scheduled. Immediately after delivery, the newborn was found to be breathless with a heart rate <60/min. During intubation and cardiac massage, the patient's femoral artery and vein were accessed. The infantogram revealed a right side tension pneumothorax. A 22 gauge needle thoracentesis relieved the right side chest pressure and a closed thoracostomy was performed. The severe acidosis was corrected with sodium bicarbonate. The patient was managed in the neonatal intensive care unit, but died from uncorrectable acidosis. We report this case with a review of the relevant literature.

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          Neonatal resuscitation.

          Thomas E Wiswell (2003)
          Ten million or more newborns worldwide each year need some type of resuscitation assistance. More than 1 million babies die annually from complications of birth asphyxia. Over the past 3 decades, neonatal resuscitation has evolved from disparate, word-of-mouth teaching methods to organized programs. The most widely-used curriculum is the Neonatal Resuscitation Program, which is supported by the American Academy of Pediatrics and the American Heart Association. To date more than 1.5 million individuals have been trained in the Neonatal Resuscitation Program. Resuscitation efforts are geared toward avoiding or mitigating the adverse sequelae of asphyxia neonatorum. Certain characteristics distinguish the preterm infant, including propensity to become hypothermic and higher potential for adverse neurologic and pulmonary complications from resuscitation efforts. In this era of evidence-based medicine the most recent Neonatal Resuscitation Program guidelines were developed to provide recommendations based on the best currently-available science. A number of major proposals received considerable scrutiny during the evaluation process. Many areas of neonatal resuscitation still need to be studied.
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            Pneumothorax in the respiratory distress syndrome: incidence and effect on vital signs, blood gases, and pH.

            E Ogata, R A Phibbs, W H Tooley … (1976)
            We determined the incidence of pneumothorax in 295 infants (mean birthweight, 1,917 gm) with the respiratory distress syndrome (RDS) treated according to the same protocol. Fifty-five infants (mean birthweight, 1,594 gm) developed pneumothorax (incidence, 19%); incidence varied with severity of RDS and intensity of respiratory assistance. Pneumothorax occurred in 3.5% (2 of 58) of infants who received no assisted ventilation and in 11% (14 of 124) of infants who received continuous positive airway pressure (CPAP) as the only form of assisted ventilation; the difference between these two groups is not significant. Forty-nine infants initially treated with CPAP later required mechanical ventilation with positive end-expiratory pressure (PEEP). Pneumothorax occurred in 12 of the 49 (24%) and in 21 of 64 (33%) of those infants initially treated with PEEP; the incidence of pneumothorax for both these groups was significantly higher than for those treated with no assisted ventilation or CPAP only. To assess the value of frequent measurement of vital signs, blood gas tensions, and pH in the recognition of pneumothorax, we analyzed these variables by the cumulative sum statistical technique. We noted the following significant changes associated with pneumothorax: arterial blood pressure, heart rate, and respiratory rate decreased in 77% of cases; pulse pressure narrowed in 51% of cases; Po2 decreased in 17 of 20 cases in which ventilatory settings were constant for at least three hours prior to pneumothorax. However, pH and Pco2 showed consistent changes. Frequent measurements of vital signs and Po2 aid in the early diagnosis of pneumothorax.
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              SPONTANEOUS ALVEOLAR RUPTURE AT BIRTH.

              Kristen M. Avery, V CHERNICK (1963)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Anesthesiol
                Journal ID (publisher-id): KJAE
                Title: Korean Journal of Anesthesiology
                Publisher: The Korean Society of Anesthesiologists
                ISSN (Print): 2005-6419
                ISSN (Electronic): 2005-7563
                Publication date (Print): December 2010
                Publication date (Electronic): 31 December 2010
                Volume: 59
                Issue: 6
                Pages: 420-424
                Affiliations
                Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Seoul, Korea.
                Author notes
                Corresponding author: Won Ho Kim, M.D., Department of Anesthesiology and Pain Medicine, Seoul Medical Center, Samseong 1-dong, Gangnam-gu, Seoul 135-740, Korea. Tel: 82-2-3430-0201, Fax: 82-2-3430-0517, bullet57@ 123456naver.com
                Article
                DOI: 10.4097/kjae.2010.59.6.420
                PMC ID: 3022137
                PubMed ID: 21253381
                SO-VID: e2463ccc-3931-4a41-a948-0224d01008cd
                Copyright © Copyright © The Korean Society of Anesthesiologists, 2010
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 01 February 2010
                Date revision received : 11 March 2010
                Date accepted : 31 March 2010
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: resuscitation of newborn,needle thoracentesis,tube thoracostomy,neonatal tension pneumothorax
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: resuscitation of newborn, needle thoracentesis, tube thoracostomy, neonatal tension pneumothorax

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