Early Recognition of Pneumothorax in Neonatal Respiratory Distress Syndrome with Electrical Impedance Tomography

A female infant, born at 34 weeks of gestation, was admitted to neonatal intensive care unit due to respiratory distress syndrome (RDS). Continuous positive airway pressure (CPAP) was started for respiratory support. She was included in an observational electrical impedance tomography (EIT) study (ClinicalTrials.gov: NCT02962505) at 18 hours of age. Swisstom BB2 EIT monitor with LuMon belt was used for collecting EIT data. Clinicians were blinded for EIT during recording. Patient condition deteriorated after 7 hours of follow-up and clinician ordered a chest X-ray, in which left-sided pneumothorax was confirmed at 17:11 (Figure 1). From 14:10 onwards, retrospective EIT analysis identified the development of pneumothorax by: 1) increased end-expiratory lung impedance (EELI) and 2) decreased tidal EIT signal variation, both at the affected side, resulting from regionally raised air content and reduced ventilation, as well as by 3) decreased EELI at the contralateral side due to mediastinal shift and compression of the lung. All effects were augmented by position change to contralateral side at 15:45. Potentially life-threatening tension pneumothorax may be prevented by early recognition of air leak complications in neonatal RDS. In our case EIT identified it almost 3 hours before the corresponding clinical diagnosis was made.