In newborns, a combination of alveoli breakage, ulcers in the lungs and overactive neonatal ventilators can cause pneumothorax, which is the caving in of an infant’s lungs due to surrounding air pressure. Other common causes of pneumothorax in newborns include breathing syndromes such as meconium aspiration syndrome or respiratory distress syndrome (RDS). The risk of pneumothorax in newborns is highest for infants born in premature births or with lung disease. If untreated, the infant’s lungs can often spontaneously recover with no medical intervention; without autonomous recovery, surgeons must use needles to extract excess air from around the lungs or risk the baby dying from suffocation.
Babies born prematurely often have respiratory systems that are highly fragile and still developing or in arrested development. Consequently, neonatal breathing is often aided by hospital ventilators that force air into the lungs of the newborn, causing the alveoli to inflate and deflate as they take on the duty of expelling gases like carbon dioxide. This forced respiration combined with the newborn’s fragile breathing organs can cause ruptures in the lungs, alveoli or both.
Alveoli are particularly susceptible to breakage since these diminutive air pouches on the lungs are formed by thin, one-layer membranes. Although a slippery surface coating keeps alveoli supple during flexing, constant mechanical ventilation can overwork even well-coated air sacs, causing tears. This is the most common reason for pneumothorax in newborns. If the alveoli don’t break, the lungs themselves might tear and develop holes if stressed by a machine ventilator.
Meconium aspiration syndrome can develop immediately after delivery when a newborn, accidentally inhales fluids from the amniotic sac, including stool, bile and other amniotic liquids. While in the womb, the baby’s lungs are not used for breathing and are in no danger of taking in the mixture, known as meconium, which the baby regularly swallows to get nutrition and filter out waste. Once the baby is born, however, any recently swallowed meconium can be sucked into the lungs during the first few breaths. Although meconium aspiration syndrome can cause pneumothorax in newborns indiscriminately, affecting babies at any stage of health or development, RDS only affects premature babies born 10 to 12 weeks early. Babies with RDS lack the special slippery coating on the alveoli that enables them to function without tearing the membrane.
Surgeons closely monitor occupants of the neonatal ward for hints of pneumothorax in newborns. Signs include rapid and labored breathing as well as a discoloring of the face so that the baby’s skin has a bluish undertone. Hyperactivity and the retraction of chest or stomach muscles are further symptoms. In addition to visual cues, medical personnel rely on instruments that measure the amount of oxygen in the newborn’s blood.