A case of a newborn infant that develops a pneumoperitoneum secondary to barotrauma is reported. Alternatives about the decision to operate or not, are presented. It is concluded that in pneumoperitoneum subsequent to a pneumothorax and/or pneumomediastinum, in association to mechanical ventilation or possible barotrauma during resuscitation, a non-surgical attitude should be taken and the indication for surgery will be given by the deteriorating condition of the patient.