SPONTANEOUS ALVEOLAR RUPTURE AT BIRTH

Abstract

Spontaneous pneumothorax in the newborn period was recognized in fifteen infants over a 6-year period. Seven of the 15 infants were symptomatic in the delivery room, which suggests that lung rupture occurred with the first few breaths. Three of the seven were meconium stained. The remaining eight infants were symptomatic within the first 24 hours. The unique features of the first breath of the newborn infant, namely, the serial opening of ventilatory units and high applied pressures, suggest that any foreign material in the airway would make rupture of opened units likely. Studies on the inflation of airless lungs demonstrate the opening phenomenon. Four of the 15 infants died, 2 from their pneumothoraces. This bad experience led us to examine principles of treatment of spontaneous pneumothorax with the recommendation that oxygen breathing in some term infants, and prompt aspiration in others would be useful. The majority, however, can be expected to resolve spontaneously. Measurements of the rate of absorption of air in the pleural cavity in the rabbit show a six-fold increase with 100% O2 breathing.