Abstract
Background: Approximately 1% of newborn infants develop air leaks in the immediate neonatal period. It is hard to differentiate air leak syndromes from other respiratory problems on clinical presentation and examination. With changes in perinatal and neonatal care, risk factors for air leaks may be changing.
Methods:: During a 2 year period (Jan. '00 to Dec. '02) neonatal and maternal records of newborn infants presenting with respiratory distress and air leak were reviewed. These infants were matched to a control group without an air leak by birth weight, gender, and gestational age. Maternal data included age, parity, pregnancy and labor complications, type of induction, length of labor, type of delivery, and presence of meconium. Infant data included attendance of NICU staff at delivery, type of resuscitation, type of air leak, need for mechanical ventilation, use of tracheal toilet and direct or delayed admission to the NICU. The burden of illness was assessed using length of NICU stay, number of x-rays done and doses of antibiotics given. Statistical analysis was carried out using parametric and non-parametric t tests where applicable. A value of p <0.05 was significant.
Results: The data below are presented as those with air leak and those without (mean ±2 S.D.). There were 27 infants in each group. The following maternal characteristics were significantly different: length of rupture of membranes 1158 ±60 min vs. 879 ±55 min (p<0.01), first stage of labor 694 ± 45 min vs. 472 ± 35 min (p<0.01), second stage of labor 95 ± 10 min vs. 73 1±3 min (p<0.05). All other maternal data were similar. In the air leak group, there were 13 right and 11 left pneumothoraces, 3 bilateral air leaks and 2 with mediastinal air. Two had needle aspiration, one was mechanically ventilated, and 2 infants had chest drains. The average number of chest x-rays in the air leak group was 3.2 ±1 vs. 1 ± 0.2 in the control group (p<0.001). The average length of NICU stay for the air leak group was 3 ±0.5 days vs. 2.25 ±0.2 days in the control group (p<0.01). 24 infants in the air leak group received more than four doses of antibiotics vs. 10 infants in the control group (p<0.05). All other infant data were similar.
Conclusion: Term infants who developed air leaks had a longer period of rupture of membranes prior to delivery and a longer duration of labor. The burden of illness was significantly higher for those infants with air leaks.
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Mirosh, M., Hayes, B., Payton, N. et al. 187 Risk Factors Associated with Respiratory Distress (RD) In Term Neonates with and without Air Leak. Pediatr Res 56, 496 (2004). https://doi.org/10.1203/00006450-200409000-00210
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DOI: https://doi.org/10.1203/00006450-200409000-00210