Pneumopericardium (PPC) in the neonatal period is a rare clinical condition, usually associated with other air leak syndrome [1-4].
The PPC, one of the serious air leak syndrome, was first reported by Bricheteau in 1844 .
It can also occur as in isolation or in association with other forms of air leak syndrome. Spontaneous PPC, occurring in absence of mechanical ventilation, is rare in term infants.
Similarly air leak syndrome was diagnosed if a neonate with MAS having decreased air entry on one or both sides of chest and supported by x-ray chest having lung collapse and tracheal daviation.
Pulmonary hypertension was the most common complication followed by air leak syndrome. It was more common in male patients as compared to females.
The CT revealed air leak syndrome including massive bilateralpneumothoraxpneumopericardium pneumomediastinumpneumoretroperitoneum and subcutaneous emphysema (Fig.1).
Cardic shock and anoxia attack owing to tension pneumopericardium could be responsible for unsuccessful resuscitation so a high index of suspicion of air leak syndrome is required during intrahospital transportation with portable ventilator especially any oxygen saturation drop.
All the clinical types of air leak syndrome originate in over distended alveoli, which ultimately rupture.
Pneumopericardium: Usually associated with other air leak syndrome and occurs in babies on high ventilator settings.
Air leak syndrome can occur in 1-2% of newborn and in up to 40% in meconium aspiration syndrome .
 demonstrated that the use of surfactant early with rapid extubation to nasal continuous positive airway pressure (NCPAP) may reduce the risk of air leak syndrome. Morley et al.
of the District of Columbia) includes information and illustrations on acute and infant respiratory distress syndromes, asthma, chronic lung disease of the newborn, cystic fibrosis, upper airway inflammatory diseases, bronchiolitis, air leak syndromes
, congenital heart disease, and neuromuscular diseases, including how to adapt equipment to neonate or pediatric patients.