Surgical treatment of pneumopericardium in the neonate

Pneumopericardium occurred in 28 neonates with respiratory distress syndrome at the University of Minnesota Hospitals and St. Paul Children's Hospital from July 1, 1972 through June 30, 1976. All patients developed this complication while on mechanical ventilatory support with positive end-expiratory pressure (2–12 cm water). In 23 patients, pneumopericardium resulted in clinical pericardial tamponade that necessitated cardiac resuscitation. The clinical presentation of pericardial tamponade consisted of muffled, distant heart sounds, hypotension, bradycardia, and hypoxia with cyanosis. The diagnosis was confirmed by chest x-ray. Pneumothorax, pneumomediastinum, and/or pneumoperitoneum were associated with the appearance of pneumopericardium in 93% of the cases. Treatment consisted of: (a) needle pericardial aspiration in 7 patients, of which 5 survived; (b) pericardial tube placement with application of suction in 10 patients, of which 8 survived; (c) no treatment in 16 patients, of which 5 survived. Overall, 13 patients (46%) survived pneumopericardium and 15 patients (54%) died. Complications of treatment developed in 5 patients; 3 developed pneumothorax and 2 developed myocardial lacerations from percutaneous placement of a plastic drainage catheter. Of 5 asymptomatic patients, 2 (40%) died as a result of pneumopericardium. Based on our experience, it is recommended that pneumopericardium be evacuated whenever it is diagnosed. Initially, needle aspiration of the pericardial sac should be performed to manage the acute episode and stabilize the patient, and then a chest catheter of No. 10 Fr. caliber should be placed under direct vision into the pericardial sac and maintained on suction until positive end-expiratory pressure ventilation has been discontinued.