Neonatal Pneumomediastinum, Spinnaker-Sail Sign: A Case Report and Review of the Literature

Background: Pneumomediastinum (PM) occurring in approximately ۰.۱% of neonates is an asymptomatic accumulation of free air in the mediastinum. In this paper, we report on a preterm newborn experiencing a significant spontaneous pneumomediastinum subsequent to an uneventful vaginal delivery in the absence of resuscitation maneuvers. Case presentation:A-۲۵۶۰ g-male newborn was delivered vaginally to a ۳۰-year-old mother at ۳۴ weeks’ gestation following an uneventful twin pregnancy. Physical examination was unremarkable except for the presence of respiratory symptoms including dyspnea and oxygen desaturation (O۲Sat<۸۵%) which required nasal continuous positive airway pressure (nCPAP). Over the ensuing day, RDS was suspected and considering the possibility of secondary surfactant insufficiency, surfactant therapy was performed. A chest X-ray obtained after ۲۴ hours was compatible with a pneumomediastinum without subcutaneous emphysema. By ۹۶ hours of age, his respiratory distress began to resolve. Chest x-ray films obtained at the ۵th day of birth showed complete reabsorption of the pneumomediastinum. Arterial blood gas measurements showed an acceptable level of gas exchange. Blood cultures taken at the referral hospital were sterile after ۴۸ hours of incubation. He was eventually discharged at good condition after ۱۳ days. This paper outlines the fundamentals of diagnosis and management of a pneumomediastinum in the neonate. Conclusion:In conclusion, spontaneous pneumomediastinum is a rare, benign condition which is usually over-diagnosed and over-treated. Conservative therapy with respiratory support and careful observation in the NICU are recommended until spontaneous resolution of the condition.

کلیدواژه ها:

Air leak syndrome Chest Radiograph Neonate Preterm Pneumomediastinum Spinnaker ، Sail sign