Spontaneous pneumothorax is more common in newborns than in any other age. Radiological data reviews indicate that pneumothorax develops in 1-2% of all newborns , and in about 0.5% of cases it is accompanied by clinical symptoms . Spontaneous pneumothorax occurs in the neonatal 2 times more common in male babies, usually in donoshen GOVERNMENTAL and post-term children . In most cases, pneumonia motoraks develops in newborns who required intensive care, as well as in cases of obstructed labor, during which produces aspiration of meconium , Blood or fusion bonds .
The frequency of pneumothorax in newborns with respirator nym distress spidromom great . The more pronounced this syndrome, the more likely it is that a pneumothorax will develop in a newborn. It was reported , that of the 295 neonates dennyh with respiratory distress -sindromom in 19% of cases developed pneumothorax. Of the children who are not the requirements familiarize auxiliary mechanical ventilation, pneumatic thorax was observed only in 3.5% of cases in children who required continuous positive airways pressure, pneumothorax developed in 11% cases in uses Vania intermittent positive pressure with positive -negative end expiratory pressure – in 29% of cases .
Pathogenesis
The pathogenesis of neonatal pneumothorax in children without respiratory distress syndrome associated with mechanical about Bloem first unfolding of the lung. Karlberg [45] showed that during the first respiratory movements of a newborn, intrapulmonary pressure averages 40 cm of water. Art., but in some cases it can reach 100 cm of water. Art. At the time of birth the alveoli are usually quickly open vayutsya and bronchial obstruction, which may occur as a result of aspiration of blood, meconium , or mucus, high pulmonary pressure meters ozhet lead to rupture of the lung . In an adult, a lung rupture occurs at an intrapulmonary pressure of 60 cm of water , in a rabbit in the neonatal period, a rupture of the lung is observed at a pressure of 45 cm of water .
In newborns with respiratory distress syndrome, pneumothorax also develops due to high intrapulmonary pressure. During spontaneous breathing newborn too negative pulmonary pressure can cos to be given at a reduced volume and reduced elasticity lay anyone. Intermittent positive pressure can also create high intrapulmonary pressure and cause the development of pneumothorax.
Clinical picture
Depending on the size of pneumothorax clinical prize Naki can either be absent or be pronounced, up to severe acute respiratory disorders. When pneumothorax small newborn clinical symptoms may not exist or may be a short osta respiratory Novki, Xia various degrees of respiratory distress , and in severe cases – pronounced acceleration of respiration (120 / min), sous roads and cyanosis . On examination reveal pneumatic thorax is often difficult due to lack of physical prize Nakov disease. The most reliable sign is the CME schenie apical heart push in the opposite direction from pneumonia motoraksa side. Since respiratory sounds are transmitted in a small size chest newborn, sni voltagerespiratory sounds on the affected side is difficult to detect .
In newborns with respiratory distress -sindromom on chalu of pneumothorax preceded by a change in vital signs . According to Ogata et al , of 49 patients with pneumothorax that complicated the distress syndrome, in 12 cases (24%), the pneumothorax was accompanied by heart block. In most other cases observed Decrease of heart rate of 10-90 beats per 1 minute, and the blood pressure decrease by 8-22 mm Hg. Art. or reducing the frequency of respiration at 8-20 in 1 min . Although the observed decrease pneumothorax Po2, obvious changes Nij pH values or DQAF been identified.
Diagnostics
The diagnosis of pneumothorax should be borne in mind at every new -born with respiratory distress -sindromom, especially with the deterioration of the clinical condition. Chest x-rays of the chest studies differentiate pneumothorax from pnevmomediastinita , disease hyaline mem branes, aspiration pneumonia, congenital lung cysts, uh fizemy lobe of the lung and diaphragmatic hernia. If pnevmoto raks quite extensive and affects clinical with standing, it should be visible on high-quality x- ray image in the front and back of direct projection . In recent years, the method of transillumination of the chest of a power of a high intensity light flux recognized Snack eye, precise and easy way to diagnose a pneumothorax in infants in the neonatal period .
Treatment
In the neonatal period of children with pneumothorax if they have no distress -sindroma and clinical symptoms or no significant symptoms should be kept under constant surveillance. In most cases, after a few days the lung is straightened. Continuous monitoring is not a requirement, as there is risk of increasing size. pneumothorax or development of intense pneumothorax (this issue will be discussed later in this chapter) . Liquid tion pneumothorax may be accelerated by supplying oxygen ,. but this should be done with caution, especially in nedonoshen GOVERNMENTAL children due to the risk of development of retinopathy of prematurity . If clinical symptoms are expressed, re mended enter drainage. In almost all cases, the air-flow ceases after 24 hours after torakostomii and administration drainage , so after 24 hours drainage mozh but extract. Thoracostomy and the introduction of drainage are shown to all newborns with distress syndrome and pneumothorax, since pneumothorax causes a further deterioration of ventilation. Typically, a slight air flow, so ispol’uet mations intermittent positive pressure can provide adequate gas exchange. However u GOVERNMENTAL sick air leakage is so large that the air of being given respirator, mostly coming out of the lungs through the bronchopleural fistula. In these patients, an adequate of gaseous Men can be achieved by high-frequency ventilation .