Factors associated with chest tube duration in neonatal pneumothorax requiring tube thoracostomy
Özkan Okur1
, Tolga Yüksel2, Özlem Yılman3, Incinur Genişol1, Mehmet Can1, Arzu Şencan2
1Department of Pediatric Surgery, University of Health Sciences, İzmir Dr. Behçet Uz Children's Hospital, İzmir, Türkiye
2Department of Pediatric Surgery, University of Health Sciences, İzmir Faculty of Medicine, Dr. Behçet Uz Children's Hospital, İzmir, Türkiye
3Department of Neonatology, University of Health Sciences, İzmir Faculty of Medicine, Dr. Behçet Uz Children's Hospital, İzmir, Türkiye
Keywords: Chest tube duration, intensive care, neonatal, newborn, pneumothorax, thoracostomy.
Abstract
Objectives: This study aimed to evaluate the clinical and radiologic characteristics of neonates with pneumothorax (PNX) requiring tube thoracostomy and to identify factors independently associated with chest tube duration.
Patients and Methods: In this retrospective single-center study, neonates who underwent tube thoracostomy for PNX between January 2020 and January 2026 were evaluated. Radiologic and follow-up variables, including PNX size, persistent air leak, and early lung re-expansion, were reviewed. The primary outcome was chest tube duration. Factors associated with duration were analyzed using univariable tests and a multivariable linear regression model.
Results: Fifty-eight neonates (38 males, 20 females; median gestational age: 37 weeks; interquartile range [IQR], 31-39) were included. Among 55 survivors, the median chest tube duration was six days (IQR, 4 to 12). Longer chest tube duration was associated with larger PNX size (p = 0.020), persistent air leak ≥ 72 h (16.5 vs. 5.0 days, p < 0.001), and absence of early lung re-expansion (9.0 vs. 5.5 days, p = 0.033), whereas timing of onset, mediastinal shift, and laterality were not. In multivariable analysis, only persistent air leak remained independently associated with prolonged duration, whereas PNX size and early lung re-expansion were no longer significant after adjustment.
Conclusion: Drainage duration appears to depend more on post-procedural resolution dynamics than on baseline presentation features. Persistent air leak and the absence of early lung re-expansion are best regarded as markers of unresolved PNX rather than independent determinants and may help identify infants likely to require prolonged drainage. These findings should be interpreted cautiously given the observational design.
Citation: Okur Ö, Yüksel T, Yılman Ö, Genişol I, Can M, Şencan A. Factors associated with chest tube duration in neonatal pneumothorax requiring tube thoracostomy. Turkish J Ped Surg 2026;40(3):129-139. doi: 10.62114/JTAPS.2026.244.