Association Between Cardiothoracic Ratio and Mortality in Neonates with Pneumothorax

Abstract

Aim:The aim of this study was to determine the effect of a reduction in the cardiothoracic ratio (CTR) on mortality in newborns with pneumothorax.Methods:Newborns with pneumothorax, who were admitted to our neonatal intensive care unit, were included in the study. The cardiothoracic ratio was calculated by dividing the transverse cardiac diameter by maximum internal thoracic diameter.Results:Of 7909 infants admitted to our neonatal intensive care unit from September 2006 to September 2017, a total of 82 (1.03%) newborns had pneumothorax. Patients who died had a lower CTR than surviving patients (0.39±0.056 and 0.44±0.048, respectively; p<0.001). It was found that the cut-off value was 0.4, area under the curve (AUC) value was 0.79, sensitivity was 68%, specificity was 87.7%, positive predictive value was 70.8%, and negative predictive value was 86.2%. Low birth weight, preterm birth, low maternal age, presence of respiratory distress syndrome, need for resuscitation at birth, and invasive mechanical ventilation were found to be significantly associated with mortality. However, among overall significant parameters, CTR and implementation of resuscitation at birth were the independent prognostic factors determined by regression analysis (p=0.001 and p=0.036, respectively).Conclusion:A CTR below 0.4% can be considered an important parameter indicating an increased risk of mortality in newborns with pneumothorax.

Keywords

• Neonatal pneumothorax
• cardiothoracic ratio
• mortality
• morbidity