352 - Association between Pneumothorax and Neonatal Outcomes among Very Preterm Infants: A Multicenter Cohort Study

Publication Number: 352.3728

Mengya Sun, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (People's Republic); Jie Yang, Fudan Children's Hospital, Shanghai, Shanghai, China (People's Republic); Xianghong Li, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (People's Republic); Hong Jiang, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China (People's Republic)

Background: The relationship between pneumothorax (PTX) and mortality and severe morbidities in very preterm infants remains contentious.

Objective: This study aimed to evaluate whether the incidence of PTX is associated with adverse neonatal outcomes in very preterm infants.

Design/Methods: This multicenter cohort study included all infants with a gestational age of 24 to 31 weeks, admitted to the tertiary neonatal intensive care units of the Chinese Neonatal Network (CHNN), from 2019 to 2022. PTX was diagnosed via chest X-ray or lung CT. The primary outcome was a composite measure of mortality and/or any severe neonatal morbidity. Multivariable logistic or linear regression analyses were performed to assess the association between PTX and neonatal outcomes. Propensity score matching was used to ensure the robustness of the results.

Results: Among the 37,917 infants in the study, 465 (1.2%) developed PTX. PTX was significantly associated with a higher risk of mortality and/or severe neonatal morbidity (aOR = 3.39, 95% CI: 2.56, 4.49). PTX exposure was also independently associated with increased mortality, moderate or severe bronchopulmonary dysplasia, and the need for invasive ventilation and its duration. Additionally, PTX was associated with an increased length of hospital stay among survivors (aOR = 7.62, 95% CI: 4.33, 10.91). The type of respiratory support after PTX and PTX treatment did not appear to affect the correlation between PTX and mortality and/or severe neonatal morbidity, although usage of high-frequency invasive mechanical ventilation after PTX and PTX treated with an intercostal chest drain seemed to have the most significant harmful effect (aORs were 3.30 and 3.47 respectively). Propensity score matching results were consistent with the main analysis, showing that PTX was significantly associated with a higher risk of mortality and/or severe neonatal morbidity (aOR = 2.48, 95% CI: 1.84, 3.35).

Conclusion(s): Our study underscores the significant impact of PTX on increasing mortality and severe morbidities in very preterm infants.