PNEUMOTHORAX AND CHEST TUBE
CONTENT
What is a pneumothorax
What causes a pneumothorax
What are the symptoms
How is it treated
What can a parent do
WHAT IS A PNEUMOTHORAX
1. A pneumothorax (new-mow-thor-ax) is sometimes called an “air leak.”
2. The lungs are surrounded by 2 “sacs” called the pleura (plur-ra). One side of the sac
covers the outside surface of the lungs while the other side of the sac covers the
chest wall.
3. These 2 sacs are close together, but there is a very small space between them. This
is called the intrapleural (in-tra-plural) space.
4. The intrapleural space is usually filled with a small amount of lubricating (lou-breekate-ing) fluid. This fluid allows the 2 sacs to move smoothly and not stick to each
other when the lung expands (gets larger) and contracts (gets smaller) during normal
breathing.
5. This is the only fluid that should be in this space.
Pneumothorax 1
6. However, sometimes a break or leak happens in one of the sacs and air enters the
intrapleural space. When this happens, it’s called a pneumothorax.
WHAT CAUSES A PNEUMOTHORAX
1. While a pneumothorax is more common in the premature baby, it may also occur in
healthy term babies.
2. Often times the term baby has no symptoms and frequently the pneumothorax
requires no treatment.
a. It usually resolves by itself in 24-28 hours.
b. In the premature baby, a pneumothorax may be a complication of the baby’s
respiratory disease or the treatment needed to help your baby’s breathing.
3. Babies at risk for having a pneumothorax are:
a. Babies who require resuscitation at birth
b. Babies who aspirate (breathe into the lungs) milk, meconium, amniotic fluid or
blood
c. Babies with Respiratory Distress Syndrome (RDS)
d. Babies on positive pressure support breathing support machine (ventilator, CPAP)
e. Babies with a lung infection
f. Babies born with a defect of the lungs.
WHAT ARE THE SYMPTOMS OF A PNEUMOTHORAX
1. If the pneumothorax is small, the baby may have no symptoms at all.
2. We may suspect a pneumothorax if your baby has any or all of the following:
a. Restlessness & irritability
b. Lethargy (sleepiness)
c. Tachypnea (breathing fast)
d. Nasal flaring, grunting (if not on respiratory support)
e. Retractions (sucking in of the chest muscles)
f. Decreased chest movement with breathing
g. Decreased oxygen level
h. Need for or increasing ventilator support
i. Bradycardia (slow heart rate)
j. Change in color: dusky, mottling, cyanosis
Pneumothorax 2
k. When the nurse or doctor listens they will hear a decreased amount of air
movement in the lungs on the side of the pneumothorax.
3. Sometimes a pneumothorax acts like other diseases. The only way to confirm a
pneumothorax is to do a chest x-ray.
HOW IS A PNEUMOTHORAX TREATED
1. A pneumothorax is a serious condition.
2. There are several ways of treating a pneumothorax. Treatment depends on the
baby’s condition and/or the size of the pneumothorax.
Treatment may include any of the following:
3. Observe the baby closely.
a. No procedures are done; we simply watch the baby and make sure their condition
does not get worse
b. We may give the baby some extra oxygen
c. This is generally the treatment for the healthy term baby with a small
pneumothorax. They usually get better on their own.
4. Insert a chest tube.
a. A small sterile tube is inserted through the chest into the air trapped between
the sacs. This small tube is called a chest tube
b. The chest tube is attached to a long tubing from a water-filled container placed
lower than or under the baby’s bed. This container helps remove the air from the
intrapleural space
c. The other side of the water-filled container is attached to a wall suction to
maintain enough pressure to remove the air
d. A stitch is used to keep the chest tube in place
e. The doctor or the Neonatal Nurse Practitioner (NNP) does this procedure
f. We usually leave the chest tube in place for several days to make sure all the air
is removed from the intrapleural space
g. When the doctor or NNP thinks all the air has been removed, he/she will order
another chest x-ray. If all the air has been removed, the chest tube will be
removed.
Pneumothorax 3
Attached to
wall suction
Water-filled
container
Attached to baby’s
chest tube
5. Go to surgery. This is very rare and is only done if the baby has multiple (more than
one) pneumothoraxes (new-mo-thor-a-sees) or has another serious lung condition
that would make it difficult to remove the air from the intrapleural space.
Pneumothorax 4
6. The doctor or NNP will decide which treatment is best for your baby. The doctor
will talk with you about his decision.
WHAT IS THE OUTCOME
1. There are usually no long-term problems from a pneumothorax.
2. The pneumothorax is resolved and the chest tube removed before the baby is
discharged home.
WHAT CAN I DO AS A PARENT
1. You can continue to visit your baby. You may not be able to hold your baby while the
chest tube is in place, but you can talk or read to your baby or sit at the baby’s bed.
Please continue to visit.
2. If you are unable to visit, please call the unit every day to check on your baby. We
will be happy to talk with you.
Reviewed/Revised:
4/03, 11/05, 4/07, 12/09
Pneumothorax 5