Adam Beaton, MD, FAAP
Pediatric Critical Care Fellow
Nicklaus Childrens Hospital
Miami, Florida
Disclosure information not submitted.
Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Neonatal Air Leak Syndromes in the United States: Analysis of the Kid’s Inpatient Database 2016
Introduction: Air leak syndromes (pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, and pneumopericardium) remain a significant cause of mortality and morbidity among neonates. Our objective was to describe the epidemiology and outcomes for air leak syndromes in neonates.
Methods: A retrospective analysis of the 2016 Kids’ inpatient database (KID 2016) was performed. Neonates 0 to 28 days were included. Air leak syndromes and associated risk factors were identified using respective ICD-10 and Clinical Classifications Software (CCS) codes. Univariate and multivariable analyses were used for data analyses. Inferential data is presented as odds ratio (OR) with 95% CI, and p-values < 0.05 are considered statistically significant.
Results: Out of 3,871,740 neonatal discharges, 18,130 developed air leak syndromes (4.68/1000 discharges). Pneumothorax (81%) accounted for the majority of air leak diagnoses followed by pneumomediastinum (13.6%), interstitial emphysema (4.6%), and pneumopericardium (0.7%). The majority of neonates with air leak syndrome was white (58.7%) and male (66.2%). The mortality rate for all air leak syndromes was 8.4%, but on multivariable analysis it was higher when associated with the use of invasive mechanical ventilation (IMV) (OR:30.0, 95%CI:22.9-39.3), Extreme prematurity (OR:28.7, 95%CI:21.8-37.8; ref: term babies), congenital diagrammatic hernia (CDH) (OR:2.5, 95%CI:1.05-6.15), congenital pneumonia (OR:2.3, 95%CI:1.9-2.9) pulmonary hemorrhage (OR:2.0, 95%CI:1.6-2.5) and respiratory distress syndrome (RDS) (OR:1.6, 95%CI:1.4-1.9). Among air leak subtypes, the highest mortality was seen in neonates with interstitial emphysema (OR 97.84; 95%CI 82.9-114). The median length of stay and total charges were 7 days (IQR 3-17) and $52,389 (IQR $21,825-$161,117), respectively.
Conclusion: This large national study describes the prevalence of air leak syndromes with current neonatal practices. Neonatal air leak is not monolithic. It is a condition with high mortality, especially when associated with invasive mechanical ventilation, extreme prematurity, pneumonia, pulmonary hemorrhage, RDS or CDH. Additionally, although pneumothorax is the most prevalent air leak syndrome, interstitial emphysema is associated with the highest mortality.