2011 OPEN FORUM Abstracts
DOES HYPEROXIC THERAPY ENHANCE THE RESOLUTION OF PNEUMOTHORAX IN THE NEONATE?
Mary T. Schneeberger, Stephen Clark, Yoav Littner, Susan Brant, Daniel Sutton, Firas Saker; Hillcrest Hospital, Mayfield Hts., OH
Background: Spontaneous pneumothorax is estimated to affect 1 to 2% of neonates shortly after birth. In most cases, small to moderate spontaneous pneumothoraces will resolve within a few days without intervention. Nitrogen wash out has been used extensively to hasten the resolution of the pneumothorax. The relationship between hyperoxic therapy and the efficacy and earlier resolution of pneumothoraces is unknown. Hyperoxic therapy may have a negative effect on the neonate due to presence of oxygen free radicals. We examined the use of hyperoxic therapy versus conventional oxygen therapy with regard to the time of resolution of the pneumothorax, as defined as time of first feed. Method: Data were obtained using a retrospective chart analysis of neonates born at Hillcrest Hospital between 2008 and 2011. Records of 83 neonates were reviewed using the ICD-9 open pneumothorax diagnosis code. Inclusion criteria were all pneumothoraces treated with oxygen for a time period greater than six hours. Definition of onset of pneumothorax was based on physical exam findings followed by chest X-ray confirmation. Resolution of pneumothorax was based on time of first feed which occurred after noted clinical improvement, lack of tachypnea, and symmetrical breath sounds. Of the 83 neonates, 57 met inclusion criteria and were divided into two groups: Hyperoxic therapy (Group 1, 30 neonates) defined as 100% high oxygen, and conventional oxygen therapy (Group 2, 27 neonates), defined as those receiving oxygen to maintain a pulse oximetry reading greater than 90%. Resolution of pneumothorax was based on time of first feed. Statistical analysis included student T test. Results: Patients in Group 1 received a significant longer exposure of O2 (hrs) when compared to Group 2 (29.7 +/- 5 SD vs. 12.6 +/- 3.9 SD, P=0.009). Length of stay (days), and time to first feeding (days) were similar in both groups (4.6 +/- 0.4 SD vs. 6.8 +/- 2.9 SD, P=0.46 and 1.63 +/- 0.2 SD vs.1.5 +/- 0.29 SD, P=0.826 respectively). Conclusion: Considering time to first feed and length of stay, both Groups 1 and 2 had similar findings. Exposure of the neonate to hyperoxic therapy in the treatment of pneumothorax may not be necessary based on this study. In order to confirm the results, further randomized, controlled trials are recommended.
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