Spontaneous Pneumomediastinum in a Term Neonate: A Case Report

Case Report

Austin J Clin Case Rep. 2021; 8(3): 1203.

Spontaneous Pneumomediastinum in a Term Neonate: A Case Report

Mawlana WH1,2*, Osman A2 and Toonisi MA2

¹Department of Pediatrics and Neonatology, Tanta University Hospital, Egypt

²Department of Pediatrics and Neonatology, King Salman Armed Forces Hospital, Saudi Arabia

*Corresponding author: Wegdan Helmy Mawlana, Department of Pediatrics and Neonatology, Tanta University Hospital, Tanta, Egypt

Received: March 09, 2021; Accepted: March 18, 2021; Published: March 25, 2021


Pneumomediastinum is an uncommon cause of respiratory distress in term infants. It could be due to many risk factors; vigorous resuscitation, pneumonia, mechanical ventilation or meconium aspiration syndrome. We present a case of spontaneous pneumomediastinum in a term baby with no identified risk factor.

Keywords: Newborn; Pneumomediastinum; Air leak


Pneumomediastinum is uncommon cause of respiratory distress in term infants. The actual incidence is unknown since most of those infants are asymptomatic [1]. Term infants with meconium aspiration syndrome, pneumonia, vigorous resuscitation at birth, lung hypoplasia and ventilator support are at high risk [2]. We report a clinical case of term infant with significant pneumomediastinum without identifiable risk factors.

Case Presentation

A term baby boy with gestational age 38+6 weeks was born by spontaneous vaginal delivery to 28 years old G2P1 Saudi female. His birth weight was 2.5kg with APGAR score 8 and 9 at 1 and 5 minutes respectively. He did not require any resuscitation. Shortly after birth he developed grunting with mild respiratory distress, so he was kept in the nursery under observation with oxygen supply by nasal cannula for 2 hours but with no improvement so he was admitted to our NICU for further investigations.

On admission baby looks well, active, not dysmorphic, vitally stable, chest examination showed grunting with fair air entry bilaterally. Other systemic exam unremarkable. Chest x- ray done at 3 hours of life showed significant pneumomediastinum with spinnaker-sail sign (Figure 1). Capillary blood gas was normal (pH 7.33, Pco2 40, Hco3 18, BE -3). SO2 was >95% on nasal cannula oxygen saturation of 21 to 25%. His respiratory distress improved dramatically with gradual weaning of nasal cannula oxygen by the second day of life. Because of significant pneumomediastinum as shown in the first x-ray, he was kept under close observation and follow up with serial x-rays till day 9 of life (Figure 2,3). It showed persistent same radiologic finding with no regression (Figure 4). For that, CT chest was done that confirmed the same finding with no other abnormalities. On admission white cell blood count was normal and blood culture was sterile. Baby was discharged home on day 10 of life with follow up after 2 weeks. Repeated X-ray done then showed resolved pneumomediastinum.