Neonatology pp 873-885 | Cite as

Pulmonary Air Leakage in Newborns

  • Paola Papoff
  • Corrado MorettiEmail author
Reference work entry


In neonates, the most common air leaks include pulmonary interstitial emphysema, pneumomediastinum, and pneumothorax, while pneumopericardium, pneumoperitoneum, and venous pulmonary embolism are less frequent. Air leaks are more common and severe among neonates with lung disease characterized by either poor lung compliance needing high ventilatory pressures or lung overdistention. Many affected neonates have minimal or no symptoms, while others present with signs of respiratory distress and increased oxygen requirement. Sudden collapse may occur in case of hypertensive pneumothorax or pneumopericardium. The diagnosis is suspected clinically and confirmed by chest X-ray. Treatment varies by type of air leak and severity of clinical condition.


  1. Aranda JV, Stern L, Dunbar JS (1972) Pneumothorax with pneumoperitoneum in a newborn infant. Am J Dis Child 123:163–166PubMedGoogle Scholar
  2. Bagchi I, Nycyk J (2002) Familial spontaneous pneumothorax. Arch Dis Child Fetal Neonatal Ed 87:F70CrossRefGoogle Scholar
  3. Benterud T, Sandvik L, Lindemann R (2009) Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate. Acta Obstet Gynecol Scand 88:359–361CrossRefGoogle Scholar
  4. Bowen FW Jr, Chandra R, Avery GB (1973) Pulmonary interstitial emphysema with gas embolism in hyaline membrane disease. Am J Dis Child 126:117–118PubMedGoogle Scholar
  5. Brook OR, Beck-Razi N, Abadi S et al (2009) Sonographic detection of pneumothorax by radiology residents as part of extended focused assessment with sonography for trauma. J Ultrasound Med 28:749–755CrossRefGoogle Scholar
  6. Brooks JG, Bustamante SA, Koops BL et al (1977) Selective bronchial intubation for the treatment of severe localized pulmonary interstitial emphysema in newborn infants. J Pediatr 91:648–652CrossRefGoogle Scholar
  7. Burt TB (1982) Neonatal pneumopericardium. Radiology 142:81–84CrossRefGoogle Scholar
  8. Caldwell EJ, Powell RD Jr, Mullooly JP (1979) Interstitial emphysema: a study of physiologic factors involved in experimental induction of the lesion. Am Rev Resp Dis 102:516–525Google Scholar
  9. Campbell RE (1970) Intrapulmonary interstitial emphysema: a complication of hyaline membrane disease. Am J Roentgenol Radium Ther Nucl Med 110:449–456CrossRefGoogle Scholar
  10. Chan V, Greenough A (1992) Severe localised pulmonary interstitial emphysema–decompression by selective bronchial intubation. J Perinat Med 20:313–316CrossRefGoogle Scholar
  11. Clark SD, Saker F, Schneeberger MT et al (2014) Administration of 100% oxygen does not hasten resolution of symptomatic spontaneous pneumothorax in neonates. J Perinatol 34:528–531CrossRefGoogle Scholar
  12. Fitzgerald D, Willis D, Usher R, Outerbridge E et al (1998) Dexamethasone for pulmonary interstitial emphysema in preterm infants. Biol Neonate 73:34–39CrossRefGoogle Scholar
  13. Greenough A, Dixon AK, Roberton NR (1984) Pulmonary interstitial emphysema. Arch Dis Child 59:1046–1051CrossRefGoogle Scholar
  14. Hart SM, McNair M, Gamsu HR, Price JF (1983) Pulmonary interstitial emphysema in very low birthweight infants. Arch Dis Child 58:612–615CrossRefGoogle Scholar
  15. Helbich TH, Popow C, Dobner MP et al (1998) Newborn infants with severe hyaline membrane disease: radiological evaluation during high frequency oscillatory versus conventional ventilation. Eur J Radiol 28:243–249CrossRefGoogle Scholar
  16. Hoffer FA, Ablow RC (1984) The cross-table lateral view in neonatal pneumothorax. AJR Am J Roentgenol 142:1283–1286CrossRefGoogle Scholar
  17. Hummler HD, Bandstra ES, Abdenour GE (1996) Neonatal fellowship.Neonatal pneumopericardium: successful treatment with nitrogen washout technique. J Perinatol 16:490–493PubMedGoogle Scholar
  18. Itani MH, Mikati MA (1998) Early onset neonatal spontaneous pneumopericardium. J Med Liban 46:165–167PubMedGoogle Scholar
  19. Jeffrey IJ (2003) The critical role of perinatal pathology. BJOG 110(Suppl 20):128–130CrossRefGoogle Scholar
  20. Johnson CH, Lang SA, Bilal H et al (2014) In patients with extensive subcutaneous emphysema, which technique achieves maximal clinical resolution: infraclavicular incisions, subcutaneous drain insertion or suction on in situ chest drain? Interact Cardiovasc Thorac Surg 18:825–829CrossRefGoogle Scholar
  21. Klinger G, Ish-Hurwitz S, Osovsky M et al (2008) Risk factors for pneumothorax in very low birth weight infants. Pediatr Crit Care Med 9:398–402CrossRefGoogle Scholar
  22. Knight PJ, Abdenour G (1981) Pneumoperitoneum in the ventilated neonate: respiratory or gastrointestinal origin? J Pediatr 98:972–974CrossRefGoogle Scholar
  23. Kuhns LR, Bednarek FJ, Wyman ML et al (1975) Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination. Pediatrics 56:355–360PubMedGoogle Scholar
  24. Lawal TA, Glüer S, Reismann M et al (2009) Spontaneous neonatal pneumomediastinum: the “spinnaker sail” sign. Eur J Pediatr Surg 19:50–52CrossRefGoogle Scholar
  25. Lee SK, Tanswell AK (1989) Pulmonary vascular air embolism in the newborn. Arch Dis Child 64:507–510CrossRefGoogle Scholar
  26. Long WA (1990) Pneumopericardium. In: Long WA (ed) Fetal and neonatal cardiology. WB Saunders, Philadelphia, pp 377–388Google Scholar
  27. Macklin CC (1939) Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum. Arch Intern Med 64:913–926CrossRefGoogle Scholar
  28. Maunder RJ (1984) Subcutaneous and mediastinal emphysema pathophysiology, diagnosis, and management. Arch Intern Med 144:147CrossRefGoogle Scholar
  29. McCallion N, Davis PG, Morley CJ (2005) Volume-targeted versus pressure-limited ventilation in the neonate. Cochrane Database Syst Rev 3, CD003666Google Scholar
  30. Meadow WL, Cheromcha D (1985) Successful therapy of unilateral pulmonary emphysema: mechanical ventilation with extremely short inspiratory time. Am J Perinatol 2:194–197CrossRefGoogle Scholar
  31. Moseley JE (1960) Loculated pneumomediastinum in the newborn. A thymic “spinnaker sail” sign. Radiology 75:788–790CrossRefGoogle Scholar
  32. Northfield TC (1971) Oxygen therapy for spontaneous pneumothorax. Br Med J 4:86–88CrossRefGoogle Scholar
  33. Ogata ES, Gregory GA, Kitterman JA et al (1976) Pneumothorax in the respiratory distress syndrome: incidence and effect on vital signs, blood gases, and pH. Pediatrics 58:177–183PubMedGoogle Scholar
  34. Pfenninger J, Bossi E, Biesold J, Blumberg A (1982) Treatment of pneumothorax, pneumopericardium and pneumomediastinum. Helv Paediatr Acta 37:353–360PubMedGoogle Scholar
  35. Primhak RA (1983) Factors associated with pulmonary air leak in premature infants receiving mechanical ventilation. J Pediatr 102:764–768CrossRefGoogle Scholar
  36. Rainer C, Gardetto A, Frühwirth M et al (2003) Breast deformity in adolescence as a result of pneumothorax drainage during neonatal intensive care. Pediatrics 111:80–86CrossRefGoogle Scholar
  37. Rastogi S, Gupta A, Wung JT et al (2007) Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan- Ganz catheter. Pediatr Radiol 37:1130e4CrossRefGoogle Scholar
  38. Shah DS, Lala R, Rajegowda B, Bhatia J (1999) Bronchogenic cyst and its progress in a premature infant. J Perinatol 19:150–152CrossRefGoogle Scholar
  39. Steele RW, Metz JR, Bass JW, DuBois JJ (1971) Pneumothorax and pneumomediastinum in the newborn. Radiology 98:629–632CrossRefGoogle Scholar
  40. Swingle HM, Eggert LD, Bucciarelli RL (1984) New approach to management of unilateral tension pulmonary interstitial emphysema in premature infants. Pediatrics 74:354–357PubMedGoogle Scholar
  41. Tarnow-Mordi WO, Reid E, Griffiths P, Wilkinson AR (1989) Low inspired gas temperature and respiratory complications in very low birthweight infants. J Pediatr 114:438–442CrossRefGoogle Scholar
  42. Volberg FM Jr, Everett CJ, Brill PW (1979) Radiologic features of inferior pulmonary ligament air collections in neonates with respiratory distress. Radiology 130:357–360CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Intensive Care UnitSapienza University of RomeRomeItaly
  2. 2.Università degli Studi di Roma “La Sapienza”RomeItaly

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