Pneumothorax in newborns: a cohort study from three NICUs

Objective: To assess pneumothorax prevalence in neonates across gestational age (GA) categories, identify associated variables, and examine the impact of bubble CPAP (b-CPAP) implementation. Study design: A cohort of 58,706 infants born at three hospitals over six years was analyzed, grouped by GA: ≥35 weeks, 29–34 weeks, and ≤28 weeks. Pneumothorax cases were matched with controls, and prevalence before and after b-CPAP adoption was compared. Results: Pneumothorax occurred in 310 infants (0.53%): 0.39% in ≥35 weeks, 4.0% in 29–34 weeks, and 4.6% in ≤28 weeks GA. Most cases occurred within 24 hours of birth, especially in ≥35 weeks (76%). In the ≥35-week group, pneumothorax was associated with male sex, chorioamnionitis, and delivery room CPAP. In the 29–34-week group, it was linked to small for gestational age, maternal diabetes, and surfactant use. In ≤28-week infants, delivery room intubation was the primary risk factor. Pneumothorax prevalence in non-intubated infants was unchanged after b-CPAP implementation (0.35% vs. 0.41%; aOR = 0.85, 95% CI: 0.62–1.16; P = 0.35). Conclusion: Delivery room interventions, not NICU b-CPAP use, were associated with neonatal pneumothorax.