Transillumination of the chest

INDICATION

Suspected pneumothorax (e.g. any deterioration in clinical condition, particularly if ventilated)

EQUIPMENT

Cold light source
Black drapes to cover incubator

PROCEDURE

Dim lights
Expose baby’s chest and abdomen
Remove all non-essential monitoring leads
Cover outside of incubator with black drapes
Place cold light tip perpendicular to and touching baby’s skin
Shine light from the side, in the 5 positions shown in diagram, comparing right side with left (5^th position shines through the liver and is used as a control)
Clean cold light tip with an alcohol wipe after use

Right side just below axilla
Left side just below axilla
Right side approximately 5^th/6^th intercostal space
Left side approximately 5^th/6^th intercostal space
Right side just below diaphragm (liver)

DIAGNOSIS

Pneumothorax confirmed if chest shines bright red
Compare both sides of chest (babies can have bilateral pneumothoraces)
Compare degree of brightness with that seen over liver
- liver and lung without pneumothorax will shine dull dark red

Caution - false positive diagnoses may be made in extremely preterm babies and those with pulmonary interstitial emphysema
Transillumination may be unreliable in babies with increased thickness of the chest wall (macrosomic term infants and those with chest wall oedema)

ACTION

If baby is unstable or haemodynamically compromised, once pneumothorax is confirmed on transillumination, perform immediate needle thoracocentesis in 2^nd intercostal space, midclavicular line on the side of the chest that shone brightly. Do not wait for a chest X-ray

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