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Chest X-ray of case no. 2 in hanging position with left-sided tension pneumothorax, mediastinal shift and pneumomediastinum. (A) At admission. (B) On day 2 showing almost fully expanded lungs. (C) On day 6 with residual pneumomediastinum but without clear radiological signs of pneumonia.
Source publication
Two neonates were presented at the Neonatology Department of the Institute of Child Nutrition and Health in Conakry, Guinea, with tension pneumothoraces as confirmed by chest X-ray. They were initially managed with needle thoracentesis but required continuous thoracic drainage. Due to scarce resources in the public health sector, no prepacked and d...
Context in source publication
Context 1
... treatment was started with ampicillin 100 mg/kg, cefotaxime 100 mg/kg both two times a day and 24-hourly gentamicin 5 mg/kg. Chest X-ray showed a left-sided pneumothorax, pneumomediastinum and mediastinal shift to the right ( figure 4). The largest available venous catheter was B: An intravenous tubing system was inserted into the intravenous bag and placed into the liquid to ensure a water seal. ...
Citations
... Few cases have been reported where an improvised underwater seal drain was used after fixation of the peripheral venous catheter for treatment of pneumothorax in neonates, and the result is conclusive and life-saving with limited resources [14]. ...
Introduction
and importance: We reported a case of secondary spontaneous pneumothorax (SSP) in a 70-years-old male with acute exacerbation of COPD (AE COPD) managed with improvised chest tube drain (ICD).
Case presentation
He presented with sudden onset breathlessness and oxygen saturation of 78%. With prolonged expiration on auscultation, he was treated as AE COPD with oxygen therapy, nebulization with albuterol/ipratropium, and injectable antibiotics and steroids. The patient was not improving with treatment on third day, and non-critical respiratory distress continued. Considering the alternative diagnosis, the chest X-ray was done which revealed right sided spontaneous pneumothorax and COPD. Due to his reluctancy to go to higher center for chest tube insertion during ongoing COVID-19 pandemic, we inserted ICD (intravenous set put in saline bottle) at our primary care. Following drainage, breathlessness improved and saturation increased. Then inpatient symptomatic treatment for COPD was continued for three more days. He was discharged on inhalers after fifth day and asked for follow up after 10 days. He came after 1 month and on repeat chest X-ray, his right sided pneumothorax resolved completely and COPD was in control with inhaled medications. There was no recurrence of pneumothorax in five months follow up.
Clinical discussion
ICD is a safe, and an alternative option in resource limited setting. However, the guidelines recommend chest tube insertion as appropriate treatment.
Conclusion
This would remind the physicians to anticipate the alternative possibility, and to re-examine those with AE COPD who are not improving as expected with oxygen and nebulization therapy.
... Its incidence is said to occur in about 1.5 to 7% of neonates in developed countries [2]. It is a life threatening condition that needs prompt intervention to prevent mortality [3]. A high index of suspicion is required to make a diagnosis as sometimes affected neonates are only vaguely symptomatic or they could have varying degrees of respiratory distress with an increasing need for oxygen, in such babies, cold lighting or attempting to illuminate the suspected area of the chest in a darkened room, then ultimately a chest X-ray can be life-saving as it confirms the diagnosis [4]. ...
... Our report reiterates why any baby with respiratory instability should have an urgent chest X-ray done. However, the role of a careful and detailed chest examination cannot be overemphasized and more so in a critically ill baby in a resource-limited setting where portable X-ray is not readily available and radiology services in general limited [3]. Chest examination findings suggestive of pneumothorax include reduced or absent breath sounds on a bulged hemithorax, tachypnea, and distant heart sounds, and reduced oxygen saturation in a baby with respiratory distress. ...
Neonatal pneumothorax occurs when air leaks into the pleural space. The appropriate size neonatal chest tube with its underwater seal is often not available in many institutions, so we improvise. We present a case report of the clinical management of a two day old male neonate with imperforate anus who had pneumothorax post colostomy creation and our improvised intervention using a size 3 endotracheal tube as our chest tube, 750 ml of water bottle as our underwater seal, and this connected to a suction machine for facilitated drainage of air from the pleural space. This case report is intended to provide an alternative method of intervention in areas where appropriately sized chest tubes underwater seal drainage systems are not available.
