Can neonatal pneumothorax be successfully managed in regional Australia

INTRODUCTION There is a lack of data reflecting the trend of neonatal pneumothorax in regional Australia. The aim of this study is to review the incidence and characteristics of neonates diagnosed with pneumothorax in Central Queensland, analyse outcomes in terms of the ability of local hospitals to manage this condition, and describe predictors for severe disease requiring transfer to a tertiary centre. Thus the role of regional health services in managing this condition will be reviewed. METHODS This was a retrospective observational study of all neonates born between 1 January 2008 and 31 December 2015 coded by hospital records with a diagnosis of neonatal pneumothorax in Central Queensland. Data for sex and birth gestation for all Central Queensland births of the same period were also obtained. Descriptive statistics were calculated for birth weight and gestation, and Apgar scores. Frequencies were calculated for sex, length of admission, age of diagnosis and risk factors including meconium aspiration syndrome (MAS), prolonged rupture of membranes (PROM) and positive pressure ventilation (PPV). The primary outcome measure was successful treatment at a Central Queensland hospital versus requirement for transfer to tertiary hospital or death prior to transfer. Statistical significance was calculated for binary and continuous variables. RESULTS During the study period, there were 31 cases of pneumothorax amongst 17 640 deliveries recorded by three Central Queensland hospitals, with a significant bias towards males (84%) amongst pneumothorax cases (p<0.001). Median gestational age was comparable between the Central Queensland population and the pneumothorax cohort. Diagnosis of pneumothorax was usually made within 48 hours of birth (87.1%). PPV was present in two-thirds of the pneumothorax cohort whilst MAS and PROM were less common. No significant relationship was found between type of pneumothorax and gender, birth weight, MAS, PROM, caesarean section or PPV. The majority of cases were successfully treated locally (67.7%) and with oxygen alone (64.5%). Other treatment modalities included surfactant use, thoracocentesis, chest tube insertion and PPV. Patients with bilateral pneumothorax or pneumomediastinum had poorer outcomes (p=0.04). Overall local outcomes were good, with only one perinatal death prior to discharge or transfer. CONCLUSION Neonatal pneumothorax is effectively managed in the regional hospitals studied in keeping with contributions of regional paediatricians and rural generalists. Compared with unilateral pneumothorax, bilateral pneumothorax or pneumomediastinum were associated with transfer to tertiary centre. There were no clear predictors for bilateral pneumothorax.