Background: Little evidence exists regarding the optimal concentration of oxygen to use in the treatment of term\nneonates with spontaneous pneumothorax (SP). The practice of using high oxygen concentrations to promote\nââ?¬Å?nitrogen washoutââ?¬Â still exists at many centers. The aim of this study was to identify the time to clinical resolution\nof SP in term neonates treated with high oxygen concentrations (HO: FiO2 ? 60%), moderate oxygen\nconcentrations (MO: FiO2 < 60%) or room air (RA: FiO2 = 21%).\nMethods: A population based cohort study that included all term neonates with radiologically confirmed\nspontaneous pneumothorax admitted to all neonatal intensive care units in Calgary, Alberta, Canada, within\n72 hours of birth between 2006 and 2010. Newborns with congenital and chromosomal anomalies, meconium\naspiration, respiratory distress syndrome, and transient tachypnea of newborn, pneumonia, tension pneumothorax\nrequiring thoracocentesis or chest tube drainage or mechanical ventilation before the diagnosis of pneumothorax\nwere excluded. The primary outcome was time to clinical resolution (hours) of SP. A Cox proportional hazards\nmodel was developed to assess differences in time to resolution of SP between treatment groups.\nResults: Neonates were classified into three groups based on the treatment received: HO (n = 27), MO (n = 35) and\nRA (n = 30). There was no significant difference in time to resolution of SP between the three groups, median\n(range 25th-75th percentile) for HO = 12 hr (8ââ?¬â??27), MO = 12 hr (5ââ?¬â??24) and RA = 11 hr (4ââ?¬â??24) (p = 0.50). A significant\ndifference in time to resolution of SP was also not observed after adjusting for inhaled oxygen concentration [MO\n(a HR = 1.13, 95% CI 0.54-2.37); RA (a HR = 1.19, 95% CI 0.69-2.05)], gender (a HR = 0.87, 95% CI 0.53-1.43) and ACoRN\nrespiratory score (a HR = 0.7, 95% CI 0.41-1.34).\nConclusions: Supplemental oxygen use or nitrogen washout was not associated with faster resolution of SP.\nInfants treated with room air remained stable and did not require supplemental oxygen at any point of their\nadmission.
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