Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report


  • Heerani Woodun Department of Pediatric Surgery, Nottingham University Hospitals NHS Trust
  • Jeremy Thomas Department of Pediatric Surgery, Nottingham University Hospitals NHS Trust
  • Dushyant Batra Department of Neonatology, Nottingham University Hospitals NHS Trust
  • Nia Fraser Department of Pediatric Surgery, Nottingham University Hospitals NHS Trust



Pneumothorax, Tube thoracocentesis, Premature, Massive air leak, Pneumoperitoneum


Background: Pneumothorax is a life-threatening condition with potential iatrogenic causes which can extend to pneumomediastinum and pneumoperitoneum.  Risk factors of spontaneous pneumothorax include prematurity, low birth weight, low APGAR scores, and cesarean-section delivery.

Case Presentation: A 1255 grams preterm boy (Twin-2) was born at 28+3 weeks of gestation by emergency lower segment cesarean section. He showed signs of respiratory distress after uncomplicated endotracheal tube insertion which was required due to apneic episodes during continuous positive airway pressure ventilation. Recurring tube thoracocentesis and high-frequency oscillatory ventilation (HFOV) treated persistent right-sided pneumothorax and nonsurgical pneumoperitoneum, with improvement on day 10, gradual removal of five chest drains by day 19, and extubation on day 24. Transillumination and chest radiography were the main diagnostic investigations. Laryngotracheobronchoscopy on day 16 identified erythema and possible old injury at the carina. He was also treated for hypotension, suspected sepsis, and pulmonary hypertension and was discharged home on day 66.

Conclusion: Identifying pneumothorax promptly is essential to reduce morbidity and mortality. Management is patient-specific and includes needle and tube thoracocentesis and often, mechanical ventilation. Our case demonstrates the challenges of managing a massive air leak in a premature newborn, who with adequate tube thoracocentesis and HFOV, successfully recovered from presumed iatrogenic persistent pneumothorax and pneumoperitoneum.


Download data is not yet available.


Metrics Loading ...


Liu J, Kurepa D, Feletti F, Alonso-Ojembarrena A, Lovrenski J, Copetti R, et al. International expert consensus and recommendations for neonatal pneumothorax ultrasound diagnosis and ultrasound-guided thoracentesis procedure. J Visualised Exp. 2020. Available from:

Benterud T, Sandvik L, Lindemann R. Cesarean section is associated with more frequent pneumothorax and respiratory problems in the neonate. Acta Obstetricia et Gynecologica Scandinavica. 2010; 88:359–61. Available from:

Gummalla P, Mundakel G, Agaronov M, Lee H. Pneumoperitoneum without intestinal perforation in a neonate: Case report and literature review. Case Rep Pediatr. 2017: 6907329. Available from:

Phuyal R, Basnet R, Sapkota A, Gautam U, Chikanbanjar KV. Pneumothorax in a preterm neonate: a case report. J Nepal Med Ass. 2021; 59:608–10. Available from:

Restaino KM, Obermeyer RJ, Tsai KW. Surgical repair of an iatrogenic tracheal injury in a very low birth weight infant. J Pediatr Surg Case Rep. 2014; 2:104–6. Available from:

Kahvecioglu D, Alan S, Gollu G, Erdeve O, Atasay B, Cakmak M, et al. Conservative treatment of neonatal pneumomediastinum with subcutaneous emphysema due to airway injury. Ankara Universitesi Tip Fakultesi Mecmuasi. 2013; 66. Available from:

Aurilia C, Ricci C, Tana M, Tirone C, Lio A, Gambacorta A, et al. Management of pneumothorax in hemodynamically stable preterm infants using high frequency oscillatory ventilation: report of five cases. Ital J Pediatr. 2017; 22:114. Available from:

Huseynov M. A first case report of neonatal persistent pneumothorax treated with an autologous blood patch. Turk Pediatri Ars. 2020; 55:438-40. Available from

Sarkar S, Hussain N, Herson V. Fibrin glue for persistent pneumothorax in neonates. J Perinatol. 2003; 23:82-4. Available from:

Altamimi T, Read B, da Silva O, Bhattacharya S. Airway injury and pneumomediastinum associated with less invasive surfactant administration in a premature neonate: a case report. BMC Pediatrics. 2021; 21:500. Available from:



How to Cite

Woodun H, Thomas J, Batra D, Fraser N. Management of massive air leak with persistent pneumothorax and pneumoperitoneum in a 1.2kg preterm neonate: A case report. J Neonatal Surg [Internet]. 2023Jan.10 [cited 2023Dec.6];12:9. Available from: