Air leak in the neonatal population can be a deadly situation. Neonates have many risk factors that can contribute to air leak. These include, but are not limited to, respiratory distress syndrome; mechanical ventilation; sepsis; pneumonia; aspiration of meconium, blood, or amniotic fluid; and congenital malformations. In the NICU, the staff must be prepared to diagnose and treat pneumothoraces in a timely manner. Pathophysiology of air leaks in the neonate including the anatomy of the chest and diagnosis, indications, and common methods for the treatment of a pneumothorax in an infant is explained in this article. In addition, the latest form of treatment for neonates, known as the modified pigtail catheter, is described. A comprehensive literature review of the evidence behind the use of the pigtail catheter in neonates will be incorporated. Finally, the step-by-step placement of this catheter using the modified Seldinger technique will be illustrated and described in detail.