Perinatal risk factors and outcomes of pulmonary air leak in very-low-birth-weight preterm infants: A multicenter registry study in Taiwan

Background: Pulmonary air leak may cause serious complications and mortality in neonates, especially preterm infants. Its incidence and perinatal risk factors in preterm infants might differ from those in term infants. We investigated the incidence, perinatal risk factors and morbidities associated with pulmonary air leak in very-low-birth-weight (VLBW) preterm infants in Taiwan.

Methods: Data from 2011 to 2015 from the nationwide multihospital registry of the Taiwan Premature Infant Follow-up Network were analyzed. Preterm infants with pulmonary air leak, including pneumothorax and pneumomediastinum, were enrolled. Data on perinatal characteristics, the course of resuscitation in the delivery room, the management of respiratory distress syndrome (RDS), and the clinical outcomes of pulmonary air leak were collected and compared between VLBW preterm infants with and without pulmonary air leak.

Results: We included 5906 VLBW preterm infants with a mean gestational age of 28.6 ± 3 weeks and mean birth weight of 1078 ± 284 g. Of them, 379 neonates (6.4%) had pulmonary air leak, with 5.4% and 1% having isolated pneumothorax and isolated pneumomediastinum, respectively. Independent risk factors for pulmonary air leak in VLBW preterm infants were male sex, a 5-min Apgar score <7, and RDS treated with surfactant. VLBW preterm infants who had higher gestational age or received nasal continuous positive airway pressure (NCPAP) had a lower risk of pulmonary air leak. However, pulmonary air leak was associated with higher rates of severe retinopathy of prematurity, severe intraventricular hemorrhage, chronic lung disease, and mortality.

Conclusions: NCPAP appeared to protect against pulmonary air leak in VLBW preterm infants. Clinicians should be aware of the risk factors for pulmonary air leak in such infants and promptly initiate meticulous ventilation strategies as needed.