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Mohsen N, Yeung T, Fadel NB, Abdul Wahab MG, Elsayed Y, Nasef N, Mohamed A. Current perception and barriers to implementing lung ultrasound in Canadian neonatal intensive care units: a national survey. Eur J Pediatr 2024:10.1007/s00431-024-05591-7. [PMID: 38787415 DOI: 10.1007/s00431-024-05591-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Despite the growing body of literature supporting the use of point-of-care lung ultrasound (POC-LU) in neonates, its adoption in Canadian neonatal intensive care units (NICUs) remains limited. This study aimed to identify healthcare providers' perceptions and barriers to implementing POC-LU in Canadian NICUs. We conducted an electronic survey targeting neonatologists, neonatal fellows, neonatal nurse practitioners, and registered respiratory therapists in 20 Canadian NICUs. The survey comprised a 28-item questionnaire divided into four sections: (1) participants' demographics and availability of POC-LU equipment, (2) experience and interest in POC-LU learning, (3) perception of POC-LU as a diagnostic tool, and (4) barriers to POC-LU implementation in NICUs. A total of 194 participants completed the survey, with neonatologists comprising the majority (45%). Nearly half of the participants (48%) reported prior experience with POC-LU. The most prevalent indications for POC-LU use were diagnosis of pleural effusion (90%), pneumothorax (87%), and respiratory distress syndrome (76%). Participants identified the primary barrier to POC-LU adoption as the lack of trained providers available for both training and clinical integration. Notably, most respondents (87%) expressed keen interest in learning neonatal POC-LU. A subgroup analysis based on the responses collected from NICU-directors of 12 institutions yielded results consistent with those of the overall participant pool. Conclusion: This survey underscores the perceived importance of POC-LU among NICU healthcare providers. A Canadian consensus is required to facilitate the development of widespread training programs as well as standardized clinical practice guideline for its implementation. What is Known: • In recent years, point-of-care lung ultrasound (POC-LU) has emerged as an important tool in neonatology, revolutionizing the assessment and management of critically ill infants. However, its adoption in Canadian Neonatal Intensive Care Units remains limited. What is New: • Most Canadian healthcare providers showed high level of interest in learning POC-LU techniques. Additionally, POC-LU was perceived as a useful tool for diagnosis and guiding intervention in various neonatal respiratory diseases. Nonetheless, the lack of expertise emerged as the primary barrier to its adoption and practice across different groups of participants regardless of their clinical experience level.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Telford Yeung
- Section of Neonatology, Windsor Regional Hospital, University of Windsor, Windsor, Canada
| | - Nadya Ben Fadel
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Yasser Elsayed
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Noori S, Ramanathan R, Lakshminrusimha S, Singh Y. Hemodynamic assessment by neonatologist using echocardiography: Primary provider versus consultation model. Pediatr Res 2024:10.1038/s41390-024-03248-7. [PMID: 38778230 DOI: 10.1038/s41390-024-03248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024]
Abstract
Hemodynamic instability is very common in sick neonates and the currently used traditional hemodynamic monitoring tools lack sensitivity and specificity. Hemodynamic evaluation on echocardiography can provide direct information regarding the pathophysiology causing the hemodynamic instability and help the bedside clinician in making a personalized treatment approach based upon the deranged pathophysiology. Assessment of cardiac function and hemodynamics is essential in the management of neonates with cardiorespiratory failure, and hence neonatologist-performed echocardiography is becoming an essential tool in modern neonatal care. Depending on the level and size of the NICU, there is a daily need for echocardiography, and for a subset of sick infants, serial echocardiographic assessments are warranted. Comprehensive guidelines for neonatologists performing echocardiography and targeted neonatal echocardiography have been published providing a framework for training and quality assurance. There has been a significant interest among the providers to learn echocardiography skills. This manuscript explores the various needs of neonatal care providers around echocardiography, the current challenges neonatologists face in learning echocardiography, and how they, especially neonatal fellows, can learn these important skills during their training.
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Affiliation(s)
- Shahab Noori
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, UC Davis Children's Hospital, UC Davis Health, Sacramento, CA, USA
| | - Yogen Singh
- Department of Pediatrics - Division of Neonatology, Loma Linda University Children's Hospital and Loma Linda University School of Medicine, Loma Linda, CA, USA
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Jhaveri V, Vali P, Giusto E, Singh Y, Lakshminrusimha S. Pneumothorax in a term newborn. J Perinatol 2024; 44:465-471. [PMID: 38409329 DOI: 10.1038/s41372-024-01899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
With the advent of surfactant and gentle ventilation, the incidence of neonatal pneumothorax has decreased over the last two decades. Pneumothorax associated with respiratory distress syndrome is more common in preterm infants, but term infants often present with isolated pneumothorax. The use of CPAP or non-invasive respiratory support in the delivery room for a term infant with respiratory distress increases transpulmonary pressures and increases the risk of pneumothorax. Prompt diagnosis with a high index of suspicion, quick evaluation by transillumination, chest X-ray or lung ultrasound is critical. Management includes observation, needle thoracocentesis and if necessary, chest tube placement. This manuscript reviews the incidence, pathogenesis, diagnosis and management of a term infant with isolated pneumothorax, summarizing the combination of established knowledge with new understanding, including data on diagnostic modes such as ultrasound, reviewing preventative measures, and therapeutic interventions such as needle thoracocentesis and a comparison of pigtail vs. straight chest tubes.
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Affiliation(s)
- Vidhi Jhaveri
- Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA.
| | - Payam Vali
- Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA
| | - Evan Giusto
- Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA
| | - Yogen Singh
- Department of Pediatrics, Loma Linda University School of Clinical Medicine, Loma Linda, CA, USA
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Alonso-Ojembarrena A, Gregorio-Hernández R, Raimondi F. Neonatal point-of-care lung ultrasound: what should be known and done out of the NICU? Eur J Pediatr 2024; 183:1555-1565. [PMID: 38315204 DOI: 10.1007/s00431-023-05375-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/07/2024]
Abstract
Lung ultrasound is rapidly becoming a useful tool in the care of neonates: its ease of use, reproducibility, low cost, and negligible side effects make it a very suitable tool for the respiratory care of all neonates. This technique has been extensively studied by different approaches in neonatal intensive care unit (NICU), both for diagnostic and prognostic aims and to guide respiratory treatments. However, many neonates are being born in level I/II hospitals without NICU facilities so all pediatricians, not just neonatal intensivists, should be aware of its potential. This is made possible by the increasing access to ultrasound machines in a modern hospital setting. In this review, we describe the ultrasonographic characteristics of the normal neonatal lung. We also discuss the ultrasound features of main neonatal respiratory diseases: transient tachypnea of the neonate (TTN), respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), pneumothorax (PNX), pleural effusion (PE), or pneumonia. Finally, we mention two functional approaches to lung ultrasound: 1. The use of lung ultrasound in level I delivery centers as a mean to assess the severity of neonatal respiratory distress and request a transport to a higher degree structure in a timely fashion. 2. The prognostic accuracy of lung ultrasound for early and targeted surfactant replacement. CONCLUSION LU is still a useful tool in level I/II neonatal units, both for diagnostic and functional issues. WHAT IS KNOWN • Neonatal lung ultrasound has been recently introduced in the usual care in many Neonatal Intensive Care Units. WHAT IS NEW • It also has many advantages in level I/II neonatal units, both for neonatologist or even pediatricians that treat neonates in those sites.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Avenida Ana de Viya, 11, 11009, Cádiz, Spain.
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
| | | | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II Di Napoli, Naples, Italy
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5
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Singh Y. Echocardiography in the neonatal unit: current status and future prospects. Expert Rev Med Devices 2024; 21:307-316. [PMID: 38526192 DOI: 10.1080/17434440.2024.2334449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision. AREA COVERED Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units. EXPERT OPINION Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations.
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Affiliation(s)
- Yogen Singh
- Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Division of Neonatology, University of Southern California, Los Angeles, USA
- Department of Pediatrics, University of Cambridge Clinical School of Medicine, Cambridge, UK
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6
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Chan B, Sieg S, Singh Y. Unveiling pseudo-pulseless electrical activity (pseudo-PEA) in ultrasound-integrated infant resuscitation. Eur J Pediatr 2023; 182:5285-5291. [PMID: 37725211 PMCID: PMC10746595 DOI: 10.1007/s00431-023-05199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
Point-of-care ultrasound (POCUS) holds immense potential to manage critically deteriorating infants within the neonatal intensive care unit (NICU) and is increasingly used in neonatal clinical practice worldwide. Recent ultrasound-based protocols such as the Sonographic Assessment of liFe-threatening Emergencies-Revised (SAFE-R) and Crashing Neonate Protocol (CNP) offer step-by-step guidance for diagnosing and addressing reversible causes of cardiorespiratory collapse. Traditionally, pulseless electrical activity (PEA) has been diagnosed solely based on absent pulses on clinical examination, disregarding myocardial activity. However, integrating POCUS into resuscitation unveils the concept of pseudo-PEA, where cardiac motion activity is observed visually on the ultrasound but fails to generate a detectable pulse due to inadequate cardiac output. Paradoxically, existing neonatal resuscitation protocols lack directives for identifying and effectively leveraging pseudo-PEA insights in infants, limiting their potential to enhance outcomes. Pseudo-PEA is extensively described in adult literature owing to routine POCUS use in resuscitation. This review article comprehensively evaluates the adult pseudo-PEA literature to glean insights adaptable to neonatal care. Additionally, we propose a simple strategy to integrate POCUS during neonatal resuscitation, especially in infants who do not respond to routine measures. CONCLUSION Pseudo-PDA is a newly recognized diagnosis in infants with the use of POCUS during resuscitation. This article highlights the importance of cross-disciplinary learning in tackling emerging challenges within neonatal medicine. WHAT IS KNOWN • Point-of-Care ultrasound (POCUS) benefits adult cardiac arrest management, particularly in distinguishing true Pulseless Electrical Activity (PEA) from pseudo-PEA. • Pseudo-PEA is when myocardial motion can be seen on ultrasound but fails to generate palpable pulses or sustain circulation despite evident cardiac electrical activity. WHAT IS NEW • Discuss recognition and management of pseudo-PEA in infants. • A proposed algorithm to integrate POCUS into active neonatal cardiopulmonary resuscitation (CPR) procedures.
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Affiliation(s)
- Belinda Chan
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City, UT, 84108, USA
- Department of Radiology and Imaging Science, University of Utah, Salt Lake City, UT, 84108, USA
| | - Susan Sieg
- Intermountain Healthcare, Salt Lake City, UT, 84108, USA
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, 11175 Coleman Pavilion, Campus Street, Loma Linda, CA, 92354, USA.
- Department of Pediatrics, Division of Neonatology, University of Southern California, Los Angeles, CA, 90089, USA.
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Padovani P, Singh Y, Pass RH, Vasile CM, Nield LE, Baruteau AE. E-Health: A Game Changer in Fetal and Neonatal Cardiology? J Clin Med 2023; 12:6865. [PMID: 37959330 PMCID: PMC10650296 DOI: 10.3390/jcm12216865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Technological advancements have greatly impacted the healthcare industry, including the integration of e-health in pediatric cardiology. The use of telemedicine, mobile health applications, and electronic health records have demonstrated a significant potential to improve patient outcomes, reduce healthcare costs, and enhance the quality of care. Telemedicine provides a useful tool for remote clinics, follow-up visits, and monitoring for infants with congenital heart disease, while mobile health applications enhance patient and parents' education, medication compliance, and in some instances, remote monitoring of vital signs. Despite the benefits of e-health, there are potential limitations and challenges, such as issues related to availability, cost-effectiveness, data privacy and security, and the potential ethical, legal, and social implications of e-health interventions. In this review, we aim to highlight the current application and perspectives of e-health in the field of fetal and neonatal cardiology, including expert parents' opinions.
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Affiliation(s)
- Paul Padovani
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Robert H. Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children’s Hospital, New York, NY 10029, USA;
| | - Corina Maria Vasile
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France;
| | - Lynne E. Nield
- Division of Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, ON M5S 1A1, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alban-Elouen Baruteau
- CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, 44000 Nantes, France;
- CHU Nantes, INSERM, CIC FEA 1413, Nantes Université, 44000 Nantes, France
- CHU Nantes, CNRS, INSERM, L’Institut du Thorax, Nantes Université, 44000 Nantes, France
- INRAE, UMR 1280, PhAN, Nantes Université, 44000 Nantes, France
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8
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Weber MD, Lim JKB, Ginsburg S, Conlon T, Nishisaki A. Translating Guidelines into Practical Practice: Point-of-Care Ultrasound for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:385-406. [PMID: 36898781 DOI: 10.1016/j.ccc.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Point-of-care ultrasound (POCUS) is now transitioning from an emerging technology to a standard of care for critically ill children. POCUS can provide immediate answers to clinical questions impacting management and outcomes within this fragile population. Recently published international guidelines specific to POCUS use in neonatal and pediatric critical care populations now complement previous Society of Critical Care Medicine guidelines. The authors review consensus statements within guidelines, identify important limitations to statements, and provide considerations for the successful implementation of POCUS in the pediatric critical care setting.
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Affiliation(s)
- Mark D Weber
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Joel K B Lim
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Sarah Ginsburg
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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Sartorius V, De Luca D. Pneumoperitoneum point-of-care ultrasound findings. Pediatr Neonatol 2022; 63:645-646. [PMID: 35659748 DOI: 10.1016/j.pedneo.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Victor Sartorius
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France.
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Le Plessis Robinson, France
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Corsini I, Parri N, Ficial B, Ciarcià M, Migliaro F, Capasso L, Savoia M, Gizzi C, Clemente M, Raimondi F, Dani C. Lung ultrasound in Italian neonatal intensive care units: A national survey. Pediatr Pulmonol 2022; 57:2199-2206. [PMID: 35637553 DOI: 10.1002/ppul.26025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Lung ultrasound (LU) is a noninvasive, bedside imaging technique that is attracting growing interest in the evaluation of neonatal respiratory diseases. We conducted a nationwide survey of LU usage in Italian neonatal intensive care units (NICUs). METHODS A structured questionnaire was developed and sent online to 114 Italian NICUs from June to September 2021. RESULTS The response rate was 79%. In the past 4 years (range: 2-6), LU has been adopted in 82% of Italian NICUs. It is the first-choice diagnostic test in 23% of the centers surveyed. The main LU diagnostic applications reported were: pneumothorax (95%), respiratory distress syndrome (89%), transient tachypnea of the newborn (89%), plural effusion (88%), atelectasis (66%), pneumonia (64%), bronchopulmonary dysplasia (43%), congenital pulmonary airway malformation (41%), and congenital diaphragmatic hernia (34%). Thirty percent of participating centers calculated LU score routinely, but only seven units used it to predict the need for surfactant replacement. Sixty-six percent of respondents learned the LU technique via a self-training process, while 34% of them visited an expert in the field for one-to-one tuition. CONCLUSIONS LU has a widespread use in Italian NICUs. However, the use of LU is extremely heterogeneous among centers. There is an urgent need to ensure standardization of clinical practice guidelines and to design and implement a formalized and accredited training program.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Marilena Savoia
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy
| | - Camilla Gizzi
- Department of Pediatrics, Sandro Pertini Hospital, ASL RM2, Rome, Italy
| | - Maria Clemente
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Carlo Dani
- Department of Neurosciences Psychology Drug Research and Child Health, Careggi University Hospital of Florence, Florence, Italy
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11
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Elsayed Y, Narvey M, Lashin A, Alammary D, Gigolyk S, Louis D. Point of care lung ultrasound service in neonatal intensive care: Five years of experience in Manitoba, Canada. J Perinatol 2022; 42:1228-1232. [PMID: 35831578 DOI: 10.1038/s41372-022-01455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/04/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the utility of a point of care lung ultrasound (POC-LUS) on patient management in the Neonatal Intensive Care Unit (NICU). STUDY DESIGN A retrospective cohort study of neonates who had POC-LUS from 2016 to 2020 in two-level III NICUs in Winnipeg, Manitoba, Canada. The primary outcome was the change in clinical management. The analysis aims mainly to describe the implementation process of the POC-LUS program. RESULTS A total of 956 neonates underwent 4076 POC-LUS studies during the study period. The number of POC-LUS studies increased significantly every year, from 316 (in 2016) to 1257 (in 2020) (p < 0.001). POC-LUS resulted in a change in clinical management following 2528 POC-LUS studies (62%), while it supported continuing the same management in 1548 studies (38%). CONCLUSION POC-LUS in Manitoba increased since its inception and led to an alteration in the clinical management in a significant proportion of patients who received the service.
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Affiliation(s)
- Yasser Elsayed
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
| | - Michael Narvey
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Asem Lashin
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Deima Alammary
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada
| | - Shere Gigolyk
- Department of respiratory therapy, St Boniface hospital, Winnipeg, Canada
| | - Deepak Louis
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada
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12
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Wang S, Li M, Ng SB. Research on Infant Health Diagnosis and Intelligence Development Based on Machine Learning and Health Information Statistics. Front Public Health 2022; 10:846598. [PMID: 35719653 PMCID: PMC9201248 DOI: 10.3389/fpubh.2022.846598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Intelligent health diagnosis for young children aims at maintaining and promoting the healthy development of young children, aiming to make young children have a healthy state and provide a better future for their physical and mental health development. The biological basis of intelligence is the structure and function of human brain and the key to improve the intelligence level of infants is to improve the quality of brain development, especially the early development of brain. Based on machine learning and health information statistics, this paper studies the development of infant health diagnosis and intelligence, physical and mental health. Pre-process the sample data, and use the filtering method based on machine learning and health information statistics for feature screening. Compared with traditional statistical methods, machine learning and health information statistical methods can better obtain the hidden information in the big data of children's physical and mental health development, and have better learning ability and generalization ability. The machine learning theory is used to analyze and mine the infant's health diagnosis and intelligence development, establish a health state model, and intuitively show people the health status of their infant's physical and mental health development by means of data. Moreover, the accumulation of these big data is very important in the field of medical and health research driven by big data.
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Affiliation(s)
- Siyu Wang
- Teachers College, Chengdu University, Chengdu, China
| | - Min Li
- Teachers College, Chengdu University, Chengdu, China
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Utilidad de la ecografía pulmonar en el diagnóstico y seguimiento de la patología respiratoria neonatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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14
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Fernández LR, Hernández RG, Guerediaga IS, Gato JM, Fanjul JR, Bilbao VA, Quintela PA, Ojembarrena AA. Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates. An Pediatr (Barc) 2022; 96:252.e1-252.e13. [DOI: 10.1016/j.anpede.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
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Bediwy AS, Al-Biltagi M, Nazeer JA, Saeed NK. Chest ultrasound in neonates: What neonatologists should know. Artif Intell Med Imaging 2022; 3:8-20. [DOI: 10.35711/aimi.v3.i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
For many years, ultrasound was thought to have no indications in pulmonary imaging because lungs are filled with air, creating no acoustic mismatch, as encountered by ultrasound wave beam. Lung ultrasound (LUS) was started in adult critical care settings to detect pleural effusion and acquired more indications over time. In the neonatal intensive care unit (NICU), the use of chest ultrasound has gained more attention during the last two decades. Being a radiation-free, bedside, rapid, and handy tool, LUS started to replace chest X-rays in NICU. Using LUS depends upon understanding the nature of normal lungs and the changes induced by different diseases. With the help of LUS, an experienced neonatologist can detect many of the respiratory problems so fast that interventional therapy can be introduced as early as possible. LUS can diagnose pleural effusion, pneumothorax, pneumonia, transient tachypnoea of the newborn, respiratory distress syndrome, pulmonary atelectasis, meconium aspiration syndrome, bronchopulmonary dysplasia, and some other disorders with very high accuracy. LUS will be helpful in initial diagnosis, follow-up, and predicting the need for further procedures such as mechanical ventilation, diuretic therapy, surfactant therapy, etc. There are some limitations to using LUS in some respiratory disorders such as bullae, interstitial emphysema, and other conditions. This review will highlight the importance of LUS, its uses, and limitations.
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Affiliation(s)
- Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Jameel Ahmed Nazeer
- Department of Radiology, University Medical center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex , Ministry of Health, Kingdom of Bahrain , Manama 12, Manama, Bahrain
- Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
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Response to the letter regarding the original article: the evolution of cardiac point of care ultrasound for the neonatologist. Eur J Pediatr 2021; 180:3579. [PMID: 34618228 DOI: 10.1007/s00431-021-04192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
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Ruoss JL, Bazacliu C, Cacho N, De Luca D. Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care? CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121098. [PMID: 34943297 PMCID: PMC8700415 DOI: 10.3390/children8121098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.
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Affiliation(s)
- J. Lauren Ruoss
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
- Correspondence:
| | - Catalina Bazacliu
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Nicole Cacho
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, 94270 Paris, France;
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