Because the baby's lungs lack the slippery substance (surfactant) that helps them stay open, the tiny air sacs are not able to expand as easily.
If the baby is put on a breathing machine (mechanical ventilator), there is extra pressure on the baby's lungs, which can sometimes burst the air sacs.
Meconium aspiration syndrome is another cause of pneumothorax in newborns. As the baby is being born, he or she may breathe in the first bowel movement, called meconium. This may cause breathing problems and the need for a breathing machine.
Less commonly, an otherwise healthy baby can develop an air leak when he or she takes the first few breaths after birth. This occurs because of the pressure needed to expand the lungs for the first time.
Pneumothorax is more common in boys than girls.
Many infants with pneumothorax do not have symptoms. When symptoms do occur, they can include:
Bluish skin color (cyanosis)
Flaring of the nostrils
Grunting with breathing
Use of other chest and abdominal muscles to aid breathing (retractions)
Signs and tests
The nurses and doctors may have difficulty hearing breath sounds when listening to the infant’s lungs with a stethoscope. The heart or lung sounds may seem as if they are coming from a different part of the chest than normal.
Tests for pneumothorax include:
Light probe placed against the baby’s chest, also known as "transillumination" (pockets of air will show up as lighter areas)
Babies without symptoms may not need treatment. The health care team will monitor your baby’s breathing, heart rate, oxygen level, and skin color.
If your baby is having symptoms, the doctor will place a needle or thin tube called a catheter into the baby’s chest to remove the air that has leaked into the chest space.
Treatment can last for a few days to a few weeks.
Some air leaks will go away within a few days without treatment. Infants who are treated by removing the air with a needle or catheter usually do well after treatment.
Although babies on breathing machines are carefully watched, air leaks can occur.
As air builds up in the chest, it can push the heart toward the other side of the chest. This puts pressure on both the lung that hasn’t collapsed and the heart. This condition is called tension pneumothorax. It is a medical emergency.
Calling your health care provider
Often pneumothorax is discovered shortly after the baby is born. Call your health care provider if your infant has symptoms of pneumothorax.
The health care providers in the newborn intensive care unit (NICU) should watch your infant carefully for signs of an air leak.
Dudell GG, Stoll BJ. Respiratory tract disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011.
Hermansen CL, Lorah KN. Respiratory distress in the newborn. Am Fam Physician. 2007;76:987-994.
Kimberly G. Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.