Pneumothorax in newborns with multisystem inflammatory syndrome associated with COVID-19: a case reports

Abstract

Currently, there is more and more data on new manifestations of COVID-19, such as multisystem inflammatory syndrome in children, which occurs with severe complications, among which cases of pneumothorax have been recorded. The article presents the experience of treating 4 newborns with a new coronovirus infection who were admitted to the clinic during 2021. In all clinical cases, children were born to mothers with a burdened obstetric history. All children had a positive RNA polymerase chain reaction for SARS-CoV-2. Children were admitted with signs of respiratory, cerebral insufficiency, gastrointestinal syndrome and metabolic disorders. The clinical picture and laboratory data corresponded to the definition of a multisystem inflammatory syndrome and was characterized not only by lung damage, but also by changes in other organs. Pneumothorax was diagnosed on days 1521. In all children, a tension pneumothorax developed on the right, in the first two cases against the background of mechanical ventilation, in the remaining two with spontaneous breathing with additional oxygenation. In one case, the pneumothorax was bilateral. Drainage of the pleural cavity in three children was carried out according to Bulau and in one case with active aspiration. Pneumothorax resolved after 414 days. Computed tomography of the chest, performed during the period of rehabilitation treatment, shows pronounced sclerotic and bullous changes in the lung parenchyma. All patients were discharged from the hospital in a satisfactory condition. Since in all the above cases, pneumothorax occurred in newborns with a burdened obstetric history of mothers, it is difficult to differentiate the occurrence of pneumothorax associated with the underlying disease, the course of labor, complications of therapy, from the disease associated with COVID-19. Stronger evidence is needed from larger datasets and rigorous analysis.