Paeds Vivas · fetal-neonatal-and-perinatal
Neonatal air-leak syndromes — branching viva
Branching viva on the unifying mechanism and classification of neonatal air leaks, recognition of the deteriorating ventilated preterm, emergency decompression, chest-drain management, and the prevention bundle.
On this page
Study tools
Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 27-week, 850 g infant on day 2 of life, ventilated for RDS, suddenly desaturates and becomes bradycardic. The left hemithorax is full with reduced air entry. The examiner asks: 'Walk me through your assessment and immediate management.'
Branch 1 — The bedside assessment
Examiner: "You are called to the cot-side. Talk me through your assessment." [9]
- Airway first: confirm ETT position at the lips and patency — the commonest cause of acute desaturation is a displaced or blocked tube. [1]
- Chest movement and symmetry: look for asymmetry — the full, less-moving left hemithorax is the clue. [9]
- Air entry: auscultate both axillae — reduced on the left. [9]
- Heart sounds and apex: assess for muffling and apical shift (shifts away from a left tension leak toward the right). [9]
- Perfusion and blood pressure: capillary refill, blood pressure, pulse pressure — narrowing pulse pressure and hypotension signal tension. [1]
- Transilluminate: cold-light fibreoptic over the left anterior chest wall in a darkened room — a bright halo confirms the pneumothorax. [9]
References6ShowHide
- [1]Aziz K Part 5: Neonatal Resuscitation 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics, 2021.PMID 33087555
- [3]Jeng MJ Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc, 2012.PMID 23158032
- [4]Rojas-Reyes MX Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev, 2012.PMID 22419276
- [9]Huseynov M Neonatal pneumothorax from the perspective of a pediatric surgeon: classification and management protocol: a preliminary algorithm. Turk J Med Sci, 2021.PMID 33433972
- [11]Cates LA Pigtail catheters used in the treatment of pneumothoraces in the neonate. Adv Neonatal Care, 2009.PMID 19212159
- [12]Greenough A Pulmonary interstitial emphysema. Arch Dis Child, 1984.PMID 6508339