Neonatal Pneumomediastinum, Spinnaker-Sail Sign: A Case Report and Review of the Literature

Pneumomediastinum (PM) occurring in approximately 0.1% of neonates is an asymptomatic accumulation of free air in the mediastinum. In this paper, we report on a preterm newborn experiencing a significant spontaneous pneumomediastinum subsequent to an uneventful vaginal delivery in the absence of resuscitation maneuvers. A-2560 g-male newborn was delivered vaginally to a 30-year-old mother at 34 weeks’ gestation following an uneventful twin pregnancy. Physical examination was unremarkableexcept for the presence of respiratory symptoms including dyspnea and oxygen desaturation (O2Sat<85%) which required nasal continuous positive airway pressure (nCPAP). Over the ensuing day, RDS was suspected and considering the possibility of secondarysurfactant insufficiency, surfactant therapy was performed. A chest X-ray obtained after 24 hours was compatible with a pneumomediastinum without subcutaneous emphysema. By 96 hours of age, his respiratory distress began to resolve. Chest x-ray films obtained at the 5th day of birth showed complete reabsorption of the pneumomediastinum. Arterial blood gas measurements showed an acceptable level of gas exchange. Blood cultures taken at the referral hospital were sterile after 48 hours of incubation. He was eventually discharged at good condition after 13 days. This paper outlines the fundamentals of diagnosis and management of a pneumomediastinum in the neonate. In conclusion, spontaneous pneumomediastinum is a rare, benign condition which is usually over-diagnosed and over-treated. Conservative therapy with respiratory support and careful observation in the NICU are recommended until spontaneous resolution of the condition.