Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 124-126  

Point of care in nursery to diagnose pneumothorax in neonates by new use of LED torch


Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Srinivas Murki
Department of Neonatology, Fernandez Hospital, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.167973

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  Abstract 

Baby, A preterm female infant, was born to a primi mother at 33 weeks of gestation with a birth weight of 1.5 kg. Tracheo-esophageal fistula was diagnosed on antenatal scan and was confirmed after birth. The infant underwent primary end-to-end anastomosis on day 2 of life and was sustained by mechanical ventilation postoperatively. On day 5 of life, when the baby was on setting of peak inspiratory pressure of 15 mm Hg/peak, end-expiratory pressure of 4 mm Hg, and FiO 2 of 30%, there was a progressive increase in pressure and oxygen requirement. Suspecting air leak transillumination test was executed with a new LED device (Vein Finder @MIHIR NICS, Hyderabad, India). Transillumination tests confirmed the pneumothorax. Chest tube was inserted and baby improved dramatically.

Keywords: LED torch, pneumothorax, point of care


How to cite this article:
Sharma D, Murki S, Pratap T. Point of care in nursery to diagnose pneumothorax in neonates by new use of LED torch . Med J DY Patil Univ 2016;9:124-6

How to cite this URL:
Sharma D, Murki S, Pratap T. Point of care in nursery to diagnose pneumothorax in neonates by new use of LED torch . Med J DY Patil Univ [serial online] 2016 [cited 2020 Aug 8];9:124-6. Available from: http://www.mjdrdypu.org/text.asp?2016/9/1/124/167973


  Introduction Top


Pneumothorax and air leaks are common complications of mechanical ventilation in neonates. [1],[2] Early diagnosis and aggressive treatment would result in optimal immediate and long term effect. Delay in diagnosis will risk the life of infants and result in hypotension, shock, and Intraventricular hemorrhage. [3] Timely diagnosis by a portable, lightweight, inexpensive device is all important. This new device used in indexed casings, cost roughly 25 pounds and weighs (90 g).


  Case Report Top


Baby, A preterm female infant, was born to a primi mother at 33 weeks of gestation with a birth weight of 1.5 kg. Tracheo-esophageal fistula was diagnosed on antenatal scan and was confirmed after birth. The infant underwent primary end-to-end anastomosis on day 2 of life and was sustained by mechanical ventilation postoperatively. On day 5 of life, when the baby was on setting of peak inspiratory pressure of 5 mm Hg/peak, end-expiratory pressure of 4 mm Hg, and FiO 2 of 30%, there was a progressive increase in pressure and oxygen requirement. Suspecting air leak transillumination test was executed with a new LED device (Vein Finder @MIHIR NICS, Hyderabad, India) [Figure 1]. Transillumination tests confirmed the pneumothorax on right side [Figure 2] with the absence of pneumothorax on the left side [Figure 3]. Chest X-ray done was suggestive of right-sided pneumothorax [Figure 4] chest tube was inserted and baby improved dramatically.
Figure 1: LED which is very low-cost device and can be used in place of fiberoptic lights

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Figure 2: Figure of baby showing right sided pneumothorax in darkness. Note the light glowing in chest

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Figure 3: Figure of baby showing absence of pneumothorax on the left side. Compare this fi gure with Figure 2 and note, the light glowing in chest is almost absent on left side in comparison to right side where light was glowing in almost right complete lung

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Figure 4: Chest X-ray showing right sided pneumothorax with mediastinal shift

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Differential diagnosis of sudden deterioration on ventilated newborns includes malfunction of auto, tube stop, tube displacement, air leaks, and pneumothorax.


  Discussion Top


Traditionally, air leaks are suspected in ventilated newborns in case of sudden deterioration, increasing PaCO 2 , differential air entry, and shift of mediastinum. [4],[5] It is confirmed with a chest radiograph. [6],[7] However, it is an emergency situation that necessitates urgent drainage of air from pleural spaces, in such conditions transillumination can help to make a diagnosis of pneumothorax in a pinch of seconds. Hence, different devices are used for transillumination test. [8] Fiberoptic transillumination is most commonly used method for diagnosis of air leaks in newborn. This device is heavy, costly, and may not be useable in all units. LED as a source of light for transillumination is an ideal alternative. As a device with LED is often portable and cost efficient. The transillumination can avoid needing of X-ray in a condition, where there is no facility of X-ray and we are suspecting strongly air leak syndrome like during transport where a neonate collapses suddenly than we can treat air leak on the basis of transillumination and also in condition where getting a radiograph will take a couple of times, at that point of time transillumination can guide the treating health care personals. [9] McIntosh et al. In their study, highlighted the use of bedside transillumination test in case of extremes, where it was utilized for drainage of pneumothorax. [10] This is similar to the importance of transillumination, which have been tried by us to highlight that transillumination can be used as a point of care in extreme condition and when radiograph will be delayed.


  Learning Points Top


  • LED torch can be used as point of care in a nursery and help in quick diagnosis of pneumothorax.
  • LED is cheap and easily used device, which can be held by all nurseries to diagnose an air leak.
  • To tell about this low-cost LED device, which can be easily procured by all NICU in comparison of fiber optic light which is very costly.


 
  References Top

1.
Malek A, Afzali N, Meshkat M, Yazdi NH. Pneumothorax after mechanical ventilation in newborns. Iran J Pediatr 2011;21:45-50.  Back to cited text no. 1
    
2.
Navaei F, Aliabadi B, Moghtaderi M, Kelishadi R. Predisposing factors, incidence and mortality of pneumothorax in a neonatal intensive care unit in Isfahan, Iran. Zhongguo Dang Dai Er Ke Za Zhi 2010;12:417-20.  Back to cited text no. 2
    
3.
Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol 2008;35:273-81, x.  Back to cited text no. 3
    
4.
Chernick V, Avery ME. Spontaneous alveolar rupture at birth. Pediatrics 1963;32:816-24.  Back to cited text no. 4
[PUBMED]    
5.
Watkinson M, Tiron I. Events before the diagnosis of a pneumothorax in ventilated neonates. Arch Dis Child Fetal Neonatal Ed 2001;85:F201-3.  Back to cited text no. 5
    
6.
Bhatia R, Davis PG, Doyle LW, Wong C, Morley CJ. Identification of pneumothorax in very preterm infants. J Pediatr 2011;159:115-120.e1.  Back to cited text no. 6
    
7.
Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000;342:868-74.  Back to cited text no. 7
    
8.
Kuhns LR, Bednarek FJ, Wyman ML, Roloff DW, Borer RC. Diagnosis of pneumothorax or pneumomediastinum in the neonate by transillumination. Pediatrics 1975;56:355-60.  Back to cited text no. 8
[PUBMED]    
9.
Baldwin S, Terndrup TE. Thoracostomy and related procedures. In: King C, Henretig FM, editors. Textbook of Pediatric Emergency Procedures. 2 nd ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 355-90.  Back to cited text no. 9
    
10.
McIntosh N, Becher JC, Cunningham S, Stenson B, Laing IA, Lyon AJ, et al. Clinical diagnosis of pneumothorax is late: Use of trend data and decision support might allow preclinical detection. Pediatr Res 2000;48:408-15.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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