Pneumothorax and Chylothorax

Respiratory distress is a common presenting feature among newborns. Thorough clinical assessment and prompt investigation are required to ensure correct treatment and improve outcomes. Pneumothorax (PTX) is the most common of the air-leak disorders in neonates and is more frequently observed in low birth weight infants. Although it is one of the few treatable causes of respiratory distress in neonatal age, it is life-threatening and is associated with an increased risk of mortality and morbidity. Incidence increases in patients with concurrent lung disease or requiring mechanical ventilation. Furthermore, neonatal PTX can develop due to high transpulmonary pressure, generated at the onset of respiration. Chylothorax is rarer, but it represents the most frequent cause of pleural effusion in the neonatal period. Clinical features depend on the amount of chyle collected in the pleural space, ranging from asymptomatic to life-threatening conditions, requiring urgent treatment. Prognosis is much better when chylothorax is diagnosed after birth than when discovered in utero, because during fetal life pleural effusion can act as a space-occupying mass resulting in pulmonary hypoplasia.