Article Text

LEVEL OF POSITIVE AIRWAY PRESSURE AND THE OCCURENCE OF PNEUMOTHORAX IN VERY LOW BIRTHWEIGHT INFANTS: A CASE–CONTROL STUDY
  1. R Kitsommart1,2,
  2. A Rahman1,
  3. G Sant’Anna1
  1. 1Department of Pediatrics, Mahidol University, Siriraj Hospital, Bangkok, Thailand
  2. 2Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada

Abstract

Objective Positive airway pressure (PAWP) is considered an important risk factor in the development of a pneumothorax in very low birthweight (VLBW) infants. The aim of this study was to determine the differences in PAWP levels between infants who developed a pneumothorax compared with controls.

Methods From April 2004 to 2007 we identified 25 VLBW infants with pneumothorax. A chart review was performed on 23 infants in whom the onset occurred during the first 7 days of life and randomly paired and matched them with a control group for a similar birthweight, gestational age, and type of ventilatory support up to the day the pneumothorax occurred. The PAWP were averaged on a time-weighted basis every 6 h during the first 120 h of life and more frequently before the onset of pneumothorax.

Results Baseline characteristics were similar between the groups. The median age of onset was 14.5 h (range 1.25–273). There was a difference between the groups in the decline of PAWP during the first 14 h of life (p<0.0001) and overall by 120 h age (p = 0.0005). The mean PAWP at the time of occurrence and 6 h before the onset was higher than at 12 h before the onset. Incidences of adverse outcomes were similar between the groups.

Conclusion Pneumothoraces were associated with higher PAWP and there was a statistically significant difference in the PAWP decline between the groups over time. The PAWP trend was notably higher before pneumothorax onset.

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