Pigtail catheter versus classic straight intercostal tube for draining of pneumothorax in neonates: A systematic review and meta-analysis

Background A controversy exists regarding the efficacy and safety of pigtail catheters (PC) versus classic straight chest tubes (SCT) for treating pneumothorax (PTX) in newborn infants. Our aim is to assess the efficacy and safety of PC compared to SCT in the treatment of PTX in newborn infants. Methods We systematically searched Medline, Embase, Cochrane, International Clinical Trials Registry Platform (ICTRP), WHO, ClinicalTrials.gov, and Google Scholar from database inception to December 2024 for randomized controlled trials, quasi control trials, and observational cohort studies. The assessed outcomes were complete radiological resolution, length of hospital stay, total days of placement, recurrence of PTX, drain dislodgment, and mortality. Results We included 3 observational studies (138 infants). Regarding the complete radiological resolution of PTX, there was no significant difference between PC and SCT [OR: 2.32; 95% CI (0.29–16.95)]. The length of hospital stay was significantly less in patients treated with PC compared to SCT [MD -14.98; 95% CI (−28.09, −1.87)] while other outcomes including total days of tube placement, recurrence of PTX, drain dislodgment, and mortality were not significantly different between the two interventions. Conclusions Our meta-analysis found no statistically significant difference in complete radiological resolution of neonatal PTX between PC and SCT. A statistically significant shorter length of hospital stay was observed with PC; however, this is heavily confounded by multiple clinical factors. Well-designed randomized controlled trials are highly recommended to establish the efficacy and safety of PCs compared to classic SCT for PTX drainage in neonates. Registration The protocol for the present systematic review was registered online with PROSPERO, the international prospective register of systematic reviews (CRD42025630790).