A 26-week preterm neonate is intubated for RDS and receiving surfactant replacement therapy. On day 4, the nurse notes sudden deterioration: SpO2 falls to 75%, heart rate drops to 90/min, bilateral breath sounds are asymmetric (reduced on right), and the trachea is deviated to the left. The IMMEDIATE intervention is:
- A Urgent portable chest X-ray to confirm pneumothorax
- B Increase FiO2 and PEEP on the ventilator
- C Needle thoracocentesis at the right 2nd intercostal space, midclavicular line ✓
- D Suction the endotracheal tube for mucus plug
Explanation
Tension pneumothorax in a ventilated premature neonate is a life-threatening emergency. The clinical triad of acute deterioration, reduced breath sounds, and tracheal deviation indicates tension physiology — X-ray confirmation delays life-saving treatment. Immediate needle thoracocentesis (2nd ICS, MCL on the affected side) must precede any imaging. In premature neonates receiving positive pressure ventilation, pneumothorax risk is significantly elevated; the asymmetric breath sounds and deviation to the left confirm right-sided tension pneumothorax. Increasing PEEP would worsen tension pneumothorax. Suctioning would only help if ETT occlusion caused acute deterioration, but bilateral asymmetric sounds and tracheal shift make pneumothorax the diagnosis.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.