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Pneumothorax (air in the chest) occurs when the lung leaks air out of the air sacs and into the space between the lungs and the bony chest wall. Ordinarily, a very thin film of fluid resides in that space, and the surface tension of the fluid keeps the lungs securely glued to the chest wall and fully expanded. If the surface tension is broken by an air leak into this space, the lungs partially collapse and respiration is compromised.
Pneumothorax may occur after resuscitation of the baby with oxygen with a pressure bag and mask, as a complication of meconium aspiration syndrome, or most often simply spontaneously when the baby takes its first big breaths. A potential weak area somewhere in the lung can rupture simply from the baby&/39;s crying efforts and establish a leak.
Signs of pneumothorax include respiratory distress in general - grunting, flaring of the nostrils (nares), and rapid breathing (tachypnea). Physical exam may find the heart sounds to be muffled (by air where there should be none) or shifted to one side of the chest (as the accumulating air pocket pushes the heart over to the side).
If a pneumothorax is severe or the baby is otherwise compromised (for example with respiratory distress syndrome), surgical placement of a plastic suction tube may be done to suck out the air as it leaks out into the pleural space around the lung. This will keep the lungs inflated and functioning adequately until the hole seals itself and the tube can be removed. Most often, the baby is placed in 100% oxygen to breathe. This way, any gas that leaks out into the pleural space will be only oxygen; oxygen in any body space will be rapidly absorbed into the bloodstream, so the pneumothorax will reabsorb faster. Again, the leak, wherever it is, should heal spontaneously in just a few days.
See also the discussion of spontaneous pneumothorax in adolescents.