Term neonate with pneumopericardium, pneumothorax while on nasal continuous positive airway pressure (nCPAP).

To cite: Pegu S, Kalapesi Z. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2016-218045 DESCRIPTION This baby girl was born at 37 weeks to a woman aged 30 years. Her birth weight was 2.99 kg. The antenatal period was uneventful with no risk factors for infection or any other high-risk conditions. The baby was born by normal vaginal delivery and required no active resuscitation at birth. Within a few minutes after birth, the baby developed respiratory distress, and hence was started on nasal continuous positive airway pressure, with pressure of 6 and FiO2 of 0.21. Auscultation revealed diminished air entry on the left side of the chest as well as muffled heart sound. Chest X-ray showed a pneumopericardium and left pneumothorax (figures 1 and 2). As there was no X-ray prior to starting CPAP, it was not possible to determine whether the air leaks were present before or initiation of the CPAP contributed to that development. Fortunately, the baby did not develop any features of cardiac tamponade and remained haemodynamically stable. CPAP was discontinued after 1 hour and then oxygen via nasal cannula was provided for the next few hours to maintain normal saturations. Follow-up chest X-ray at 6 hours revealed near resolution of the pneumopericardium. Neonatal pneumopericardium is an uncommon condition with potential serious morbidity and mortality. It is known to be associated with other air leak syndromes (pneumomediastinum, pneumothorax, pneumoperitoneum, and subcutaneous and interstitial emphysema). Active resuscitation and assisted ventilation in premature babies with respiratory distress syndrome are potential risk factors for this condition. But there are also case reports where pneumopericardium has occurred spontaneously. Chest radiography can confirm the diagnosis of pneumopericardium and would show air surrounding immediately the heart shadow. Pneumopericardium could present with minimal clinical findings and no haemodynamic instability or manifest with tamponade-like symptoms with cardiac decompensation and death. Close monitoring would suffice for asymptomatic patients, but symptomatic patients with tension pneumopericardium would need emergency pericardiocentesis. 3