Introduction: Pneumothorax is a potentially life-threatening complication in preterm neonates, frequently associated with respiratory distress syndrome (RDS). Prompt diagnosis and individualized respiratory support are essential to avoid invasive interventions.
Objective: To describe the successful conservative management of a preterm neonate with respiratory distress syndrome complicated by pneumothorax and congenital infection, emphasizing the role of early respiratory support and infection control.
Methods: A male infant was born prematurely with clinical signs of systemic inflammation and respiratory distress. Initial management in the delivery room included thermal stabilization, tactile stimulation, and continuous positive airway support. Blood gas analysis revealed mild mixed acidosis. Chest radiography confirmed pneumothorax and respiratory distress syndrome. The patient was managed conservatively with intratracheal surfactant (100 mg per kilogram per dose), right lateral positioning and high-frequency oscillatory ventilation, without pleural drainage.
Results: The patient responded favorably to supportive management. Respiratory status improved progressively. Oxygen requirements decreased rapidly, and the pneumothorax resolved without invasive intervention. Extubation was achieved on the second day of life, and oxygen therapy was stopped by day six. The patient remained hemodynamically stable, tolerated enteral feeding, and showed appropriate weight gain. On day seven, he was transferred to the neonatal prematurity unit for continued monitoring of growth and jaundice.
Conclusions: This case supports the safety and effectiveness of conservative management in selected preterm neonates with pneumothorax. Early surfactant administration combined with high-frequency oscillatory ventilation (HFOV) can facilitate recovery while avoiding the risks associated with pleural drainage [2]. Tailored respiratory strategies and early control of systemic infection are essential for optimizing outcomes in vulnerable neonates.