Chest Intercostal Drainage for Neonatal Spontaneous Pneumothorax: A Rare Case Report

Background: Spontaneous Pneumothorax (SP) is only 0.05% to 0.1% of all live births with symptomatic pneumothorax and rarely occurs in term (1-2%) with the healthy condition after birth. The management of SP depends on the symptoms. If there is a sign of symptomatic pneumothorax, an intercostal catheter is needed.

Case presentation: A 2,535-gram and 48-cm-length female neonate was born by Caesarean Section from G2P1A0 37 weeks of pregnancy with severe preeclampsia. At birth, the baby did not cry immediately, with an Apgar Score of 5-7-8. After 2 hours of observation, the baby experienced rapid and deep breaths. Thorax X-Ray showed a right pneumothorax causing right pulmonary collapse and pushing the mediastinum toward the left, with normal cor configuration. The patient fell into a respiratory failure condition. It was decided to conduct a chest intercostal drainage in the right 4th intercostal space (ICS) anterior axillary line. After the chest intercostal drainage insertion, a thorax x-ray for evaluation was performed. Thorax X-Ray showed a chest tube inserted in the right 4th ICS anterior axillary line, neonatal pneumonia, normal cardiothoracic ratio, and no appearance of right pneumothorax. Four days after the chest intercostal drainage insertion, it was removed. Five days after the onset of pneumothorax, a thorax contrast CT scan was performed to investigate if there were any pulmonary abnormalities. Contrast CT scan showed no pneumothorax, or atelectasis, with normal cardiothoracic ratio. Eight days after the onset of pneumothorax, the patient was discharged with a stable condition.

Conclusion: Symptomatic spontaneous pneumothorax in a healthy neonate after birth is rare, but appropriate and adequate treatment is required. Knowing the risk factors, pathomechanism, and monitoring neonates at risk can help provide the best care for the patient. Further investigation of the risk factors for SP is needed for better monitoring, management, and outcome.