case Study – A 37-year-old woman with no medical historypresented to the hospital at 26 weeks and 3 days of gestation withpreterm labor. Her blood pressure was 126/74 mm Hg and her heartrate (HR) was 91 beats per minute. Ultrasound sonography showed thefetus with a breech presentation, a weight of approximately 900grams, and an HR of 150 beats per minute. The neonate was 830 gramsat birth, a female with no abnormalities. The infant was limp withan HR of 80 beats per minute and an SpO2 of 77% with no breathingeffort. The 1-minute Apgar score was 1. Positive pressureventilation by mask was delivered using a T-piece resuscitator.Peak inspiratory pressure (PIP) was 20 cm H2O and positiveend-expiratory pressure (PEEP) was 4 cm H2O. SpO2 continued to fallto 50%, HR was 70 beats per minute, and soft tissue swelling in theright supraclavicular area was observed. The patient was intubatedwith a 2.5 uncuffed orotracheal tube. However, the neonate’s SpO2was maintained at 50% even following intubation. On physicalexamination, worsening of soft tissue swelling in the right neck,axillary, and supraclavicular areas was found and crepitus waspalpable. Abdominal distension and severe cyanosis were observedconcurrently. A chest radiograph confirmed the presence ofpulmonary air leaks. A needle thoracentesis was performed to treata right-sided tension pneumothorax. Fifty mL of air was aspiratedin the intercostal space of the midclavicular line using a 22-gaugeangiocatheter. Following air aspiration, ventilation was achievedfor both lungs with the use of the Burnell Jet Ventilator, and theloss of edema in the neck area and reduction of subcutaneousemphysema were observed. The neonate’s SpO2 gradually rose to mid80s and HR was maintained at 170 beats per minute. The neonate wastransferred to the neonatal intensive care unit, wherehigh-frequency jet ventilation was continued.
What are the risk factors for air leaks in the neonate?
What noninvasive procedure uses a bright light probe placedagainst the infant’s chest wall to diagnose a pneumothorax?
Name the two techniques for treating air leaks
