214 - Risk factors for pneumothorax in late preterm and term infants receiving CPAP on admission and its impact on in-hospital outcomes

Poster Number: 214
Publication Number: 214.3247

Background: Pneumothorax is one of the morbidities in late preterm and term infants receiving continuous positive airway pressure (CPAP) for respiratory distress at birth. The antenatal and perinatal factors associated with the development of pneumothorax and its impact on outcomes has not been well studied.

Objective: To determine the association between pneumothorax and in-hospital outcomes and identify risk factors in late preterm and term infants receiving CPAP on admission.

Design/Methods: We conducted a retrospective cohort study of all inborn infants with gestational age (GA) ≥ 34w who were admitted to the NICU on nasal CPAP within 12h of birth. Infants with congenital anomalies were excluded.
In-hospital outcomes and perinatal factors were compared between pneumothorax and no-pneumothorax groups using Chi-Square for categorical and T test for continuous variables, or nonparametric Mann-Whitney U Test as determined by Shapiro-Wilk test. Multivariate stepwise binary logistic regression (LRA) was used to model the association between demographic and perinatal factors and pneumothorax.

Results: Of 268 eligible infants on CPAP, 29 (11%) developed pneumothorax. More infants in pneumothorax group required intubation (24% vs 10%, p .019), surfactant (21% vs 6%, p .023), and prolonged antibiotic course (38% vs 9.6%; p <.001). Infants in the pneumothorax group had longer duration of respiratory support (2.5 (6.0)d vs .5 (.5)d, median (IQR), p<.001), duration of parenteral nutrition (3.0 (4.0)d vs 2.0 (2.0)d, median (IQR), p<.001), and length of hospital stay (7.0 (8.0)d vs 4.0 (5.0)d, median (IQR); p .042). (Table 1)
Infants in pneumothorax group were born at higher GA (39 (3.3)w 37.2 (3.0)w, median (IQR), p.001). More infants in pneumothorax group were of male gender, SGA, were exposed to maternal smoking, and meconium-stained amniotic fluid. There was no significant difference between groups for the need for positive pressure ventilation during resuscitation or oxygen requirement on admission. (Table 2)
On LRA, higher GA, male gender, and prolonged rupture of membrane (PROM) were associated with increased risk of pneumothorax. (Figure)

Conclusion(s): In this study, 10% of late preterm and term infants admitted on CPAP developed pneumothorax which was associated with worse in-hospital outcomes. Higher GA, male gender and PROM were associated with increased risk of pneumothorax. These associations need to be further evaluated in larger prospective studies.
Figure.jpeg

Table 1.jpeg

Table 2.jpeg