Anaesthesia, 1976, Volume 31, pages 403-405 CASE REPORT

Neonatal pneumothorax A simple drainage device

B. L. D U F F Y

Pneumothorax occurring in the newborn can be a potentially fatal event. This is an account of the use of simple equipment to achieve immediate effective relief. Case report A live male infant was delivered by Caesarean section performed under general anaesthesia. The baby required resuscitation and was intubated with a 3.0 mm Portex neonatal resuscitation tube, but in spite of ventilation with 100% oxygen spontaneous respiration failed to develop and cyanosis increased. At this stage it was observed that chest movements were absent on the right side and air entry could not be detected on auscultation. A chest radiograph taken with a portable X-ray machine revealed a total right-sided pneumothorax with complete collapse of the lung (Fig. 1). A No. 1 Braunula was rapidly inserted into the mid-axillary line to release the existing tension. Under-water-seal drainage was quickly established using a Baxter ‘Plexitron’ blood administration set connected to the air vent of a Baxter ‘Vacoliter’ bottle (Fig. 2). Free drainage was immediately obtained with considerable improvement in the condition of the baby who soon started to breathe spontaneously. The baby was transferred to the paediatric intensive care nursery where good progress continued to be made. On the 3rd day the Braunula was accidentally dislodged from the pleural cavity but a subsequent chest radiograph showed that no further drainage was required. The child was eventually discharged home with no obvious after-effects. Discussion Neonatal pneumothorax due to alveolar rupture may have an incidence as high as 1”/,. Rupture may be spontaneous or may be iatrogenic.’ With the tendency to institute early resuscitative measures in order to prevent cerebral damage there is an increased likelihood of pneumothorax being produced. Often the infant may be symptomless B. C. D d y , FFARCS, Consultant Anaesthetist, Nchanga North Hospital, Chingola, Zambia.

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B. L. Duffy

Fig. 1.

but the development of tension pneumothorax, as occurred in this case, is a lifethreatening situation. The apparatus describedhere is readily available in all units. It is sterileand can be assembled in seconds. There is minimal dead space and minimal resistance to escaping air. Solutions containing dextrose should not be used as these will tend to encourage bacterial growth. A similar arrangement has since been used successfully in an adult patient. Summary

A simple method of providing under-water-seal drainage using readily available equipment is described. It enables adequate treatment of pneumothorax to be instituted with the minimum of delay. Acknowledgments The author is grateful to the medical, nursing, and radiographic staff for assistance in the management of this case and to Mrs S. Helliesen for secretarial assistance. Mr V. Grout kindly supplied the photographs.

Neonatal pneumothorax

Fig. 2.

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Neonatal pneumothorax. A Simple drainage device.

A simple method of providing under-water-seal drainage using readily available equipment is described. It enables adequate treatment of pneumothorax t...
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