To explore the clinical features and treatment of neonatal pneumopericardium, and review the literatures.

On April 21, 2018, a neonate with pneumopericardium and 1 h+ 22 min after birth was selected as research subject. The neonate was delivered by cesarean section in Sichuan Provincial Hospital for Women and Children and developed shortness of breath, moan and purple complexion about 10 min after birth, and then was transferred into Department of Neonatology, Sichuan Provincial Hospital for Women and Children. The clinical data of the neonate was collected by retrospective analysis method, and the clinical features, diagnosis and treatment methods of the neonate were summarized. With the following keywords of " neonate" and " pneumopericardium" both in Chinese and English, literatures related to neonatal pneumopericardium were searched from PubMed database, Wily Online Library, Wanfang Data Knowledge Service Platform, and VIP database, and literatures retrieval time was set from January 1, 2008 to June 30, 2018, and clinical features, diagnosis and treatment methods of neonatal pneumopericardium in searched literature were summarized. This study was consistent with the World Medical Association Declaration of Helsinki revised in 2013.

The results of the neonate with pneumopericardium in this study were as follows. ①Family history: the neonate was a boy with 36 weeks of gestational age, and without premature rupture of membranes, intrauterine distress or history of meconium-stained amniotic fluid. His birth weight was 2 750 g, and the Apgar scores were 9, 10, 10 points at 1, 9, and 10 min after birth, respectively. ②Results of admission examinations: chest X-ray radiography showed the possibility of wet-lung complicated with infection, and neonatal respiratory distress syndrome (NRDS) to be discharged. Arterial blood gas analysis suggested respiratory acidosis. There was no obvious abnormity in color doppler ultrasound examination of heart, and examinations of blood routine, C-reactive protein and electrolyte, and liver and kidney functions. ③Treatment and outcome: under the treatment of ventilator-assisted mechanical ventilation, a large amount of pneumopericardium occurred in the neonate, combined with other symptoms of air leak syndromes, such as pneumothorax, mediastinal emphysema, interstitial emphysema, and subcutaneous emphysema, and combined with pericardial tamponade and decreased cardiac output. Clinically, the neonate was not treated with routine pericardiocentesis, but was treated with thoracentesis and high frequency oscillation ventilation (HFOV) treatment. After the neonate receiving this method, the pericardial gas was completely absorbed within 24 h. After 30 d of hospitalization, the neonate was cured and discharged from hospital. The results of literatures review were as follows. A total of 14 literatures about neonatal pneumopericardium were retrieved, involving 15 cases of neonates with pneumopericardium. Among them, 8 cases were not complicated with pericardial tamponade, except 1 case with massive pneumopericardium was treated by pericardiocentesis, other 7 cases were treated with oxygen inhalation, and all the 8 cases were cured and discharged. Among the 15 cases of neonates with pneumopericardium, the other 7 cases with pericardial tamponade underwent pericardiocentesis, including 6 cases with continuous drainage and 4 cases with thoracentesis. Two neonates died after giving up treatment, the other 5 neonates were cured and discharged. Among the 5 neonates discharged from hospital, 2 neonates had pericardiocentesis failure, and then one of them received the treatment of HFOV, thoracocentesis and drainage, and the other one received the treatment of thoracocentesis and drainage and intermittent mandatory ventilation (IMV), and both of them achieved good treatment results.

Conservative treatment strategies are recommended for pneumopericardium in neonates with stable vital signs and cardiac hemodynamics, even when combined with pericardial tamponade. Thoracocentesis combined with HFOV therapy may be effective in improving the state of pneumopericardium in neonates while avoiding the risks that pericardiocentesis may cause.