Background: This study aimed to retrospectively evaluate the demographic characteristics, risk factors, treatment outcomes, and factors affecting mortality in neonatal pneumothorax cases treated with chest tubes in a tertiary neonatal intensive care unit.

Methods: Data from 97 neonates diagnosed with neonatal pneumothorax and treated with chest tubes between January 2019 and October 2023 were analyzed in a retrospective cohort design. Patients' demographic characteristics, clinical findings, accompanying comorbidities, treatment processes, and outcomes were analyzed. Factors affecting mortality were determined using univariate and multiple logistic regression analyses.

Results: Of the 97 cases included in the study, 72.2% were male. The mean gestational age was 33.4 ± 4.6 weeks, and the mean birth weight was 2313 ± 1022 grams. A diagnosis of pneumothorax was made within the first three days of life in 74.2% of cases. Pneumothorax was most commonly located on the right side (49.5%), and the most common accompanying pathologies were respiratory distress syndrome (33.0%) and congenital pneumonia (24.7%). The overall mortality rate was found to be 37.1%. In multiple logistic regression analysis, 5th minute Apgar score <7 (adjusted OR: 6.64; 95% CI: 2.07-21.28; p=0.001), presence of bilateral pneumothorax (adjusted OR: 4.44; 95% CI: 1.12-17.62; p=0.034), and low birth weight (OR: 8.41 for 1500-2499 g; OR: 9.53 for <1500 g) were determined as independent mortality predictors.

Conclusion: The findings of this five-year retrospective cohort study demonstrate that mortality is significantly high in neonatal pneumothorax cases treated with chest tube. Low birth weight, low 5th minute Apgar score and the presence of bilateral pneumothorax are strong and independent predictors of mortality. Close monitoring and early aggressive treatment approaches are essential to reduce mortality in newborns with these risk factors.