Newborn infants with severe respiratory distress syndrome have an increased incidence of pulmonary interstitial emphysema, pneumomediastinum, and pneumothorax. A chest tube inserted for treatment of a pneumothorax may inadvertently perforate the lung. Recognition of chest tube perforation can be suggested by the occurrence of: (1) persistent or repeated pneumothoraces despite the presence of a chest tube and (2) atelectasis and/or infiltrate near the end of the chest tube.