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Elsayed Y, Sheldon J, Gigolyk S. The Impact of Respiratory Therapist Performed Point-of-Care Lung Ultrasound on the Respiratory Care in Neonates, Manitoba Experience, Canada. Am J Perinatol 2024; 41:e1539-e1545. [PMID: 37072013 DOI: 10.1055/s-0043-1768042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE We aimed to evaluate the impact of the registered respiratory therapist (RRT) performed point-of-care lung ultrasound (POC-LUS) on patient management in the neonatal intensive care unit (NICU). STUDY DESIGN This is a retrospective cohort study of neonates who had RRT performed POC-LUS in two level III NICUs in Winnipeg, Manitoba, Canada. The analysis aims mainly to describe the implementation process of the POC-LUS program. The primary outcome was the prediction of the change in clinical management. RESULTS A total of 136 neonates underwent 171 POC-LUS studies during the study period. POC-LUS resulted in a change in clinical management following 113 POC-LUS studies (66%), while it supported continuing the same management in 58 studies (34%). The lung ultrasound severity score (LUSsc) was significantly higher in the group with worsening hypoxemic respiratory failure and on respiratory support than infants on respiratory support and stable or not on respiratory support, p < 0.0001. LUSsc was significantly higher in infants on either noninvasive or invasive than those not on respiratory support, p-value <0.0001. CONCLUSION RRT performed POC-LUS service utilization in Manitoba improved and guided the clinical management of 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, Manitoba, Canada
| | - Josh Sheldon
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Shere Gigolyk
- Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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Donda K, Babu S, Rastogi D, Rastogi S. Risk Factors for Pneumothorax and Its Association with Ventilation in Neonates. Am J Perinatol 2024; 41:e1531-e1538. [PMID: 37072012 DOI: 10.1055/s-0043-1768070] [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] [Indexed: 04/20/2023]
Abstract
OBJECTIVE The mode of ventilation that is implicated in pneumothorax is the one at the time of its diagnosis. Although there is evidence that air leak starts many hours before it is clinically evident, there are no prior studies that have investigated the association of pneumothorax with the mode of ventilation few hours before rather than at the time of its diagnosis. STUDY DESIGN A retrospective case-control study was conducted in the neonatal intensive care unit (NICU) between 2006 and 2016 where cases of neonates with pneumothorax were compared with gestational age-matched control neonates without pneumothorax. Respiratory support associated with pneumothorax was classified as the mode of ventilation 6 hours before the clinical diagnosis of pneumothorax. We investigated the factors that were different between cases and controls, and between cases of pneumothorax on bubble continuous positive airway pressure (bCPAP) and invasive mechanical ventilation (IMV). RESULT Of the 8,029 neonates admitted in the NICU during the study period, 223 (2.8%) developed pneumothorax. Among these, 127 occurred among 2,980 (4.3%) neonates on bCPAP, 38 among 809 (4.7%) neonates on IMV, and the remaining 58 among 4,240 (1.3%) neonates on room air. Those with pneumothorax were more likely to be male, have higher body weight, require respiratory support and surfactant administration, and have bronchopulmonary dysplasia (BPD). Among those who developed pneumothorax, there were differences in the gestational age, gender, and use of antenatal steroids between those who were on bCPAP as compared to those on IMV. IMV was associated with increased odds of pneumothorax as compared to those on bCPAP in a multivariable regression analysis. Cases on IMV had higher incidence of intraventricular hemorrhage, retinopathy of prematurity, BPD, and necrotizing enterocolitis, as well as longer length of stay as compared to those on bCPAP. CONCLUSION Neonates who require any respiratory support have higher incidence of pneumothorax. Among those on respiratory support, those on IMV had higher odds of pneumothorax and worse clinical outcomes as compared to those on bCPAP. KEY POINTS · The process of air leak leading to pneumothorax in majority of neonates starts much before it is clinically diagnosed.. · It is possible to detect the air leak early in the process by subtle changes in the signs, symptoms and changes in lung function.. · True association of the ventilation associated with pneumothorax is not at the time of diagnosis of pneumothorax but few hours before it is diagnosed.. · There is higher incidence of pneumothorax in neonates on any respiratory support.. · There is significantly higher incidence of pneumothorax among neonates on invasive ventilations as compared to noninvasive ventilation after correction for all other clinical factors..
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Affiliation(s)
- Keyur Donda
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Sharmila Babu
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York
| | - Deepa Rastogi
- Division of Pulmonary Medicine, Childrens National Hospital George Washington University, Washington, District of Columbia
| | - Shantanu Rastogi
- Division of Neonatology, Childrens National Hospital George Washington University, Washington, District of Columbia
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Alonso-Ojembarrena A, Ehrhardt H, Cetinkaya M, Lavizzari A, Szczapa T, Sartorius V, Rocha G, Sindelar R, Wald M, Heiring C, Soukka H, Danhaive O, Roehr CC, Cucerea M, Calkovska A, Dimitriou G, Barzilay B, Klingenberg C, Schulzke S, Plavka R, Tameliene R, O'Donnell CPF, van Kaam AH. Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327068. [PMID: 38604653 DOI: 10.1136/archdischild-2024-327068] [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: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. DESIGN AND INTERVENTION International online survey. RESULTS Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%-98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique. CONCLUSIONS Although LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Research Unit, Puerta del Mar University Hospital, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cadiz, Spain
| | - Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine. Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Merih Cetinkaya
- Health Sciences University, Başaksehir. Cam and Sakura City Hospital, Istanbul, Turkey
| | - Anna Lavizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Victor Sartorius
- Divivion of Paediatric and Neonatal Critical Care, Hôpital Antoine-Béclère, Clamart, France
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, University Hospital Salzburg, Salzburg, Austria
| | - Christian Heiring
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanna Soukka
- Department of Pediatrics and Adolescent Medicine, University Hosptial of Turky and Turku University, Turku, Finland
| | - Olivier Danhaive
- Division of Neonatology, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK
- Newborn Services, Southmead Hospital. North Bristol Trust, Bristol, UK
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Targu Mures, Romania
| | - Andrea Calkovska
- Department of Physiology, Jessenius Faculty of Medicine. Comenius University, Bratislava, Slovakia
| | | | - Bernard Barzilay
- Neonatology Division, Mayanei Hayeshua Medical Center, Bnei Brak, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromso, Norway
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital, Basel, Switzerland
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Rasa Tameliene
- Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
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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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Bianzina S, Singh Y, Iacobelli R, Amodeo A, Guner Y, Di Nardo M. Use of point-of-care ultrasound (POCUS) to monitor neonatal and pediatric extracorporeal life support. Eur J Pediatr 2024; 183:1509-1524. [PMID: 38236403 DOI: 10.1007/s00431-023-05386-2] [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: 12/03/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive life support technique that requires a blood pump, an artificial membrane lung, and vascular cannulae to drain de-oxygenated blood, remove carbon dioxide, oxygenate, and return it to the patient. ECMO is generally used to provide advanced and prolonged cardiopulmonary support in patients with refractory acute cardiac and/or respiratory failure. After its first use in 1975 to manage a severe form of meconium aspiration syndrome with resultant pulmonary hypertension, the following years were dominated by the use of ECMO to manage neonatal respiratory failure and limited to a few centers across the world. In the 1990s, evidence for neonatal respiratory ECMO support increased; however, the number of cases began to decline with the use of newer pharmacologic therapies (e.g., inhaled nitric oxide, exogenous surfactant, and high-frequency oscillatory ventilation). On the contrary, pediatric ECMO sustained steady growth. Combined advances in ECMO technology and bedside medical management have improved general outcomes, although ECMO-related complications remain challenging. Point-of-care ultrasound (POCUS) is an essential tool to monitor all phases of neonatal and pediatric ECMO: evaluation of ECMO candidacy, ultrasound-guided ECMO cannulation, daily evaluation of heart and lung function and brain perfusion, detection and management of major complications, and weaning from ECMO support. Conclusion: Based on these considerations and on the lack of specific guidelines for the use of POCUS in the neonatal and pediatric ECMO setting, the aim of this paper is to provide a systematic overview for the application of POCUS during ECMO support in these populations. What is Known: • Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary support for patients with refractory acute cardiac and/or respiratory failure and requires appropriate monitoring. • Point-of-care ultrasound (POCUS) is an accessible and adaptable tool to assess neonatal and pediatric cardiac and/or respiratory failure at bedside. What is New: • In this review, we discussed the use of POCUS to monitor and manage at bedside neonatal and pediatric patients supported with ECMO. • We explored the potential use of POCUS during all phases of ECMO support: pre-ECMO assessment, ECMO candidacy evaluation, daily evaluation of heart, lung and brain function, detection and troubleshooting of major complications, and weaning from ECMO support.
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Affiliation(s)
- Stefania Bianzina
- Pediatric Anaesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yogen Singh
- Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Roberta Iacobelli
- Area of Cardiac Surgery, Cardiology, Heart and Lung Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Yigit Guner
- Pediatric Surgery, Children's Hospital of Orange County and University of California Irvine, Orange, CA, USA
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
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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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Rigotti C, Zannin E, Dellacà RL, Ventura ML. Combining lung ultrasound and oscillatory mechanics for assessing lung disease in very preterm infants. Pediatr Res 2024; 95:1022-1027. [PMID: 37857847 DOI: 10.1038/s41390-023-02829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND We investigated whether combining lung ultrasound scores (LUSs) and respiratory system reactance (Xrs) measured by respiratory oscillometry explains the severity of lung disease better than individual parameters alone. METHODS We performed a prospective observational study in very preterm infants. Forced oscillations (10 Hz) were applied using a neonatal mechanical ventilator (Fabian HFOi, Vyaire). We used the simultaneous respiratory severity score (RSS = mean airway pressure × FIO2) as a primary outcome. We built linear mixed-effect models to assess the relationship between Xrs z-score, LUS and RSS and compared nested models using the likelihood ratio test (LRT). RESULTS We enrolled 61 infants (median (Q1, Q3) gestational age = 30.00 (26.86, 31.00) weeks) and performed 243 measurements at a postnatal age of 26 (13, 41) days and postmenstrual age of 33.14 (30.46, 35.86) weeks. Xrs z-score and LUS were independently associated with simultaneous RSS (p < 0.001 for both). The model including Xrs and LUS explained the RSS significantly better than Xrs (p value LRT < 0.001) or LUS alone (p value LRT < 0.001). CONCLUSIONS Combining LUS and Xrs z-score explains the severity of lung disease better than each parameter alone and has the potential to improve the understanding of the underlying pathophysiology. IMPACT Combining respiratory system reactance by oscillometry and lung ultrasound score explains the respiratory support requirement (e.g., proxy of the severity of lung disease) significantly better than each parameter alone. We assessed the relationship between lung ultrasound and respiratory system reactance in very preterm infants for the first time. Combining respiratory oscillometry and lung ultrasound has the potential to improve the understanding of respiratory pathophysiology.
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Affiliation(s)
- Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Raffaele L Dellacà
- TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Chidini G, Raimondi F. Lung ultrasound for the sick child: less harm and more information than a radiograph. Eur J Pediatr 2024; 183:1079-1089. [PMID: 38127086 DOI: 10.1007/s00431-023-05377-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
In the realm of emergency medicine, the swift adoption of lung ultrasound (LU) has extended from the adult population to encompass pediatric and neonatal intensivists. LU stands out as a bedside, replicable, and cost-effective modality, distinct in its avoidance of ionizing radiations, a departure from conventional chest radiography. Recent years have witnessed a seamless adaptation of experiences gained in the adult setting to the neonatal and pediatric contexts, underscoring the versatility of bedside Point of care ultrasound (POCUS). This adaptability has proven reliable in diagnosing common pathologies and executing therapeutic interventions, including chest drainage, and central and peripheral vascular cannulation. The surge in POCUS utilization among neonatologists and pediatric intensivists is notable, spanning economically advanced Western nations with sophisticated, high-cost intensive care facilities and extending to low-income countries. Within the neonatal and pediatric population, POCUS has become integral for diagnosing and monitoring respiratory infections and chronic and acute lung pathologies. This, in turn, contributes to a reduction in radiation exposure during critical periods of growth, thereby mitigating oncological risks. Collaboration among various national and international societies has led to the formulation of guidelines addressing both the clinical application and regulatory aspects of operator training. Nevertheless, unified guidelines specific to the pediatric and neonatal population remain lacking, in contrast to the well-established protocols for adults. The initial application of POCUS in neonatal and pediatric settings centered on goal-directed echocardiography. Pivotal developments include expert statements in 2011, the UK consensus statement on echocardiography by neonatologists, and European training recommendations. The Australian Clinician Performed Ultrasound (CPU) program has played a crucial role, providing a robust academic curriculum tailored for training neonatologists in cerebral and cardiac assessment. Notably, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) recently disseminated evidence-based guidelines through an international panel, delineating the use and applications of POCUS in the pediatric setting. These guidelines are pertinent to any professional tending to critically ill children in routine or emergency scenarios. In light of the burgeoning literature, this paper will succinctly elucidate the methodology of performing an LU scan and underscore its primary indications in the neonatal and pediatric patient cohort. The focal points of this review comprise as follows: (1) methodology for conducting a lung ultrasound scan, (2) key ultrasonographic features characterizing a healthy lung, and (3) the functional approach: Lung Ultrasound Score in the child and the neonate. Conclusion: the aim of this review is to discuss the following key points: 1. How to perform a lung ultrasound scan 2. Main ultrasonographic features of the healthy lung 3. The functional approach: Lung Ultrasound Score in the child and the neonate What is Known: • Lung Ultrasound (LUS) is applied in pediatric and neonatal age for the diagnosis of pneumothorax, consolidation, and pleural effusion. • Recently, LUS has been introduced into clinical practice as a bedside diagnostic method for monitoring surfactant use in NARDS and lung recruitment in PARDS. What is New: • Lung Ultrasound (LUS) has proven to be useful in confirming diagnoses of pneumothorax, consolidation, and pleural effusion. • Furthermore, it has demonstrated effectiveness in monitoring the response to surfactant therapy in neonates, in staging the severity of bronchiolitis, and in PARDS.
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Affiliation(s)
- Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Anaesthesia, Intensive Care and Emergency Medicine Department, Milan, Italy.
| | - Francesco Raimondi
- Neonatal Intensive Care Unit, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
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Maddaloni C, De Rose DU, Ronci S, Pugnaloni F, Martini L, Caoci S, Bersani I, Conforti A, Campi F, Lombardi R, Capolupo I, Tomà P, Dotta A, Calzolari F. The role of point-of-care ultrasound in the management of neonates with congenital diaphragmatic hernia. Pediatr Res 2024; 95:901-911. [PMID: 37978315 DOI: 10.1038/s41390-023-02889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
In the last few years, current evidence has supported the use of point-of-care ultrasound (POCUS) for a number of diagnostic and procedural applications. Considering the valuable information that POCUS can give, we propose a standardized protocol for the management of neonates with a congenital diaphragmatic hernia (CDH-POCUS protocol) in the neonatal intensive care unit. Indeed, POCUS could be a valid tool for the neonatologist through the evaluation of 1) cardiac function and pulmonary hypertension; 2) lung volumes, postoperative pleural effusion or pneumothorax; 3) splanchnic and renal perfusion, malrotations, and/or signs of necrotizing enterocolitis; 4) cerebral perfusion and eventual brain lesions that could contribute to neurodevelopmental impairment. In this article, we discuss the state-of-the-art in neonatal POCUS for which concerns congenital diaphragmatic hernia (CDH), and we provide suggestions to improve its use. IMPACT: This review shows how point-of-care ultrasound (POCUS) could be a valid tool for managing neonates with congenital diaphragmatic hernia (CDH) after birth. Our manuscript underscores the importance of standardized protocols in neonates with CDH. Beyond the well-known role of echocardiography, ultrasound of lungs, splanchnic organs, and brain can be useful. The use of POCUS should be encouraged to improve ventilation strategies, systemic perfusion, and enteral feeding, and to intercept any early signs related to future neurodevelopmental impairment.
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Affiliation(s)
- Chiara Maddaloni
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
- PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome "Tor Vergata", Rome, Italy.
| | - Sara Ronci
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Ludovica Martini
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Stefano Caoci
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Roberta Lombardi
- Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Flaminia Calzolari
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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Bao LY, Dao XY, Du K. Progress in the Application of Lung Ultrasound for the Evaluation of Neonates with Respiratory Distress Syndrome. J Multidiscip Healthc 2024; 17:1-9. [PMID: 38192739 PMCID: PMC10771789 DOI: 10.2147/jmdh.s442464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Neonatal respiratory distress syndrome (NRDS) is a common critical disease in neonates. Early diagnosis and timely treatment are crucial. Historically, X-ray imaging was the primary method for diagnosing NRDS. However, this method carries radiation exposure risks, making it unsuitable for dynamic lung condition monitoring. In addition, neonates who are critically ill require bedside imaging, but diagnostic delays are often unavoidable due to equipment transportation and positioning limitations. These challenges have been resolved with the introduction of lung ultrasound (LUS) in neonatal intensive care. The diagnostic efficacy and specificity of LUS for NRDS is superior to that of X-ray. The non-invasive, dynamic, and real-time benefits of LUS also allow for real-time monitoring of lung changes throughout treatment for NRDS, yielding important insights for guiding therapy. In this paper, we examine the ultrasonographic characteristics of NRDS and the recent progress in the application of ultrasound in the diagnosis and treatment of NRDS while aiming to promote wider adoption of this method.
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Affiliation(s)
- Ling-Yun Bao
- Department of Neonate, Kun Ming Children’s Hospital, Yunnan, 650021, People’s Republic of China
| | - Xin-Yue Dao
- Department of Neonate, Kun Ming Children’s Hospital, Yunnan, 650021, People’s Republic of China
| | - Kun Du
- Department of Neonate, Kun Ming Children’s Hospital, Yunnan, 650021, People’s Republic of China
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Gupta R, Bandyopadhyay T, Yadav B, Guleria M, Maria A. Sonographic assessment of diaphragmatic thickness and excursion to predict CPAP failure in neonates below 34 weeks of gestation: A prospective cohort study. Pediatr Pulmonol 2023; 58:2889-2898. [PMID: 37530492 DOI: 10.1002/ppul.26608] [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: 04/03/2023] [Revised: 06/26/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND To evaluate the diagnostic accuracy of sonographic assessment of diaphragmatic dimensions and excursions in predicting Continuous Positive Airway Pressure (CPAP) failure in preterm neonates with respiratory distress. METHODS Prospective cohort study among preterm neonates less than 34 weeks of gestation who were hemodynamically stable and either admitted with respiratory distress or who developed respiratory distress shortly after admission to the NICU and having Silverman-Anderson Score (SAS) ≥ 3/10 were included. We performed sonographic assessment of diaphragmatic dimensions and excursions before and one hour ±30 minutes after application of CPAP. 'CPAP failure' was defined as combined outcome of the need of surfactant and/or upgradation of respiratory support within first 72 hours after a trial of CPAP. Clinical parameters and diaphragmatic measurements were compared between CPAP failure and success groups. RESULTS Of 62 participants, 20 (32%) failed CPAP. On binomial logistic regression (after adjustment for gestational age and birth weight), initial SAS, higher diaphragmatic excursion (both left and right, before and after CPAP application), lower left hemidiaphragm diaphragmatic thickness fraction (DTF) (before CPAP application) and lower right DTF (after CPAP application) were independent predictors of CPAP failure. However, the receiver-operating characteristics curves showed that excursions of right and left hemi-diaphragm both before and after CPAP application, had highest accuracies in predicting CPAP failure (AUC 0.84, 0.80 and 0.86, 0.78, respectively; p < .001). CONCLUSION Diaphragmatic excursion can be a useful parameter to predict the failure of CPAP in preterm neonates with respiratory distress.
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Affiliation(s)
- Rashi Gupta
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | | | - Bharti Yadav
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Munish Guleria
- Department of Radiodiagnosis, ABVIMS & Dr. RML Hospital, New Delhi, India
| | - Arti Maria
- Department of Neonatology, ABVIMS & Dr. RML Hospital, New Delhi, India
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12
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Perri A, Sbordone A, Patti ML, Nobile S, Tirone C, Giordano L, Tana M, D'Andrea V, Priolo F, Serrao F, Riccardi R, Prontera G, Lenkowicz J, Boldrini L, Vento G. The future of neonatal lung ultrasound: Validation of an artificial intelligence model for interpreting lung scans. A multicentre prospective diagnostic study. Pediatr Pulmonol 2023; 58:2610-2618. [PMID: 37417801 DOI: 10.1002/ppul.26563] [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: 01/17/2023] [Revised: 05/28/2023] [Accepted: 06/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Artificial intelligence (AI) is a promising field in the neonatal field. We focused on lung ultrasound (LU), a useful tool for the neonatologist. Our aim was to train a neural network to create a model able to interpret LU. METHODS Our multicentric, prospective study included newborns with gestational age (GA) ≥ 33 + 0 weeks with early tachypnea/dyspnea/oxygen requirements. For each baby, three LU were performed: within 3 h of life (T0), at 4-6 h of life (T1), and in the absence of respiratory support (T2). Each scan was processed to extract the region of interest used to train a neural network to classify it according to the LU score (LUS). We assessed sensitivity, specificity, positive and negative predictive value of the AI model's scores in predicting the need for respiratory assistance with nasal continuous positive airway pressure and for surfactant, compared to an already studied and established LUS. RESULTS We enrolled 62 newborns (GA = 36 ± 2 weeks). In the prediction of the need for CPAP, we found a cutoff of 6 (at T0) and 5 (at T1) for both the neonatal lung ultrasound score (nLUS) and AI score (AUROC 0.88 for T0 AI model, 0.80 for T1 AI model). For the outcome "need for surfactant therapy", results in terms of area under receiver operator characteristic (AUROC) are 0.84 for T0 AI model and 0.89 for T1 AI model. In the prediction of surfactant therapy, we found a cutoff of 9 for both scores at T0, at T1 the nLUS cutoff was 6, while the AI's one was 5. Classification accuracy was good both at the image and class levels. CONCLUSIONS This is, to our knowledge, the first attempt to use an AI model to interpret early neonatal LUS and can be extremely useful for neonatologists in the clinical setting.
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Affiliation(s)
- Alessandro Perri
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
- Department of Woman and Child Health Sciences, Child Health Area, Catholic University of Sacred Heart Seat of Rome, Rome, Lazio, Italy
| | - Annamaria Sbordone
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Maria Letizia Patti
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Stefano Nobile
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Chiara Tirone
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Lucia Giordano
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Milena Tana
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Vito D'Andrea
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Francesca Priolo
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Francesca Serrao
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Riccardo Riccardi
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Isola Tiberina, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Jacopo Lenkowicz
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Luca Boldrini
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
- Department of Woman and Child Health Sciences, Child Health Area, Catholic University of Sacred Heart Seat of Rome, Rome, Lazio, Italy
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13
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Gregorio-Hernández R, Ramos-Navarro C, Vigil-Vázquez S, Rodríguez-Corrales E, Pérez-Pérez A, Arriaga-Redondo M, Sánchez-Luna M. Lung ultrasound and postoperative follow-up of congenital diaphragmatic hernia. Eur J Pediatr 2023; 182:3973-3981. [PMID: 37368006 DOI: 10.1007/s00431-023-05074-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Lung ultrasound (LU) has emerged as a valuable tool for assessing pulmonary aeration noninvasively, rapidly, and reliably in different neonatal conditions. However, its role in the preoperative and postoperative evaluation in congenital diaphragmatic hernia (CDH) is still poorly analyzed. We present a cohort of 8 patients diagnosed with CDH who underwent lung ultrasound examinations at various time points before and after surgical correction. The lung ultrasound patterns were compared between two groups: mechanical ventilation ≤ 7 days (MV ≤ 7) and mechanical ventilation > 7 days (MV > 7). The ultrasound findings were also compared to CT scans and chest X-ray images to assess its diagnostic capacity for identifying postoperative complications: pneumothorax, pleural effusion, and pneumonia. Group MV ≤ 7 exhibited a normal pattern even at 48 h postsurgery, while group MV > 7 presented interstitial or alveolointerstitial pattern in both lungs for prolonged periods (2-3 weeks). Furthermore, contralateral LU pattern may be predictive of respiratory evolution. Conclusion: Lung ultrasound is a valuable tool for evaluating the progressive reaeration of the lung following surgical correction in CDH patients. It demonstrates the ability to diagnose common postoperative complications without the need for radiation exposure while offering the advantages of quick and serial assessments. These findings highlight the potential of lung ultrasound as an effective alternative to conventional imaging methods in the management of CDH. What is Known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in neonatal patients. What is New: • Lung ultrasound is useful in the postsurgical management of congenital diaphragmatic hernia patients, detecting reaeration and respiratory complications.
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Affiliation(s)
| | - C Ramos-Navarro
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - S Vigil-Vázquez
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - A Pérez-Pérez
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - M Sánchez-Luna
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
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14
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Sett A, Rogerson SR, Foo GWC, Keene J, Thomas N, Kee PPL, Zayegh A, Donath SM, Tingay DG, Davis PG, Manley BJ. Estimating Preterm Lung Volume: A Comparison of Lung Ultrasound, Chest Radiography, and Oxygenation. J Pediatr 2023; 259:113437. [PMID: 37088185 DOI: 10.1016/j.jpeds.2023.113437] [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: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To determine the relationship between lung ultrasound (LUS) examination, chest radiograph (CXR), and radiographic and clinical evaluations in the assessment of lung volume in preterm infants. STUDY DESIGN In this prospective cohort study LUS was performed before CXR on 70 preterm infants and graded using (1) a LUS score, (2) an atelectasis score, and (3) measurement of atelectasis depth. Radiographic diaphragm position and radio-opacification were used to determine global and regional radiographic atelectasis. The relationship between LUS, CXR, and oxygenation was assessed using receiver operator characteristic and correlation analysis. RESULTS LUS scores, atelectasis scores, and atelectasis depth did not correspond with radiographic global atelectasis (area under receiver operator characteristics curves, 0.54 [95% CI, 0.36-0.71], 0.49 [95% CI, 0.34-0.64], and 0.47 [95% CI, 0.31-0.64], respectively). Radiographic atelectasis of the right upper, right lower, left upper, and left lower quadrants was predicted by LUS scores (0.75 [95% CI, 0.59-0.92], 0.75 [95% CI, 0.62-0.89], 0.69 [95% CI, 0.56-0.82], and 0.63 [95% CI, 0.508-0.751]) and atelectasis depth (0.66 [95% CI, 0.54-0.78], 0.65 [95% CI, 0.53-0.77], 0.63 [95% CI, 0.50-0.76], and 0.56 [95% CI, 0.44-0.70]). LUS findings were moderately correlated with oxygen saturation index (ρ = 0.52 [95% CI, 0.30-0.70]) and saturation to fraction of inspired oxygen ratio (ρ = -0.63 [95% CI, -0.76 to -0.46]). The correlation between radiographic diaphragm position, the oxygenation saturation index, and peripheral oxygen saturation to fraction of inspired oxygen ratio was very weak (ρ = 0.36 [95% CI, 0.11-0.59] and ρ = -0.32 [95% CI, -0.53 to -0.07], respectively). CONCLUSIONS LUS assessment of lung volume does not correspond with radiographic diaphragm position preterm infants. However, LUS predicted radiographic regional atelectasis and correlated with oxygenation. The relationship between radiographic diaphragm position and oxygenation was very weak. Although LUS may not replace all radiographic measures of lung volume, LUS more accurately reflects respiratory status in preterm infants. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12621001119886.
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Affiliation(s)
- Arun Sett
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia.
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia
| | - Gillian W C Foo
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia
| | - Jacqui Keene
- Department of Radiology, The Royal Women's Hospital, Melbourne, Australia
| | - Niranjan Thomas
- Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Penny P L Kee
- Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia
| | - Amir Zayegh
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Victoria, Australia
| | - David G Tingay
- Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
| | - Brett J Manley
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
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15
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Rojas-García A, Moreno-Blanco D, Otero-Arteseros M, Rubio-Bolívar FJ, Peinado H, Elorza-Fernández D, Gómez EJ, Quintana-Díaz M, Sánchez-Gonzalez P. SIMUNEO: Control and Monitoring System for Lung Ultrasound Examination and Treatment of Neonatal Pneumothorax and Thoracic Effusion. SENSORS (BASEL, SWITZERLAND) 2023; 23:5966. [PMID: 37447813 DOI: 10.3390/s23135966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Training with real patients is a critical aspect of the learning and growth of doctors in training. However, this essential step in the educational process for clinicians can potentially compromise patient safety, as they may not be adequately prepared to handle real-life situations independently. Clinical simulators help to solve this problem by providing real-world scenarios in which the physicians can train and gain confidence by safely and repeatedly practicing different techniques. In addition, obtaining objective feedback allows subsequent debriefing by analysing the situation experienced and learning from other people's mistakes. This article presents SIMUNEO, a neonatal simulator in which professionals are able to learn by practicing the management of lung ultrasound and the resolution of pneumothorax and thoracic effusions. The article also discusses in detail the hardware and software, the main components that compose the system, and the communication and implementation of these. The system was validated through both usability questionnaires filled out by neonatology residents as well as through follow-up sessions, improvement, and control of the system with specialists of the department. Results suggest that the environment is easy to use and could be used in clinical practice to improve the learning and training of students as well as the safety of patients.
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Affiliation(s)
- Adriana Rojas-García
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Diego Moreno-Blanco
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Martin Otero-Arteseros
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Helena Peinado
- Servicio de Neonatología, Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
| | | | - Enrique J Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
| | - Manuel Quintana-Díaz
- CEASEC-Fundación para la Investigación Biomédica del Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
- Servicio de Medicina Intensiva, Hospital Universitario La Paz de Madrid, 28046 Madrid, Spain
| | - Patricia Sánchez-Gonzalez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain
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Pryor EJ, Davies IM, Crossley KJ, Thiel AM, McGillick EV, Rodgers K, Nitsos I, Kitchen MJ, Blank DA, Hooper SB. Assessing lung aeration using ultrasound after birth in near-term lambs at risk of respiratory distress. Front Pediatr 2023; 11:1148443. [PMID: 37284289 PMCID: PMC10239949 DOI: 10.3389/fped.2023.1148443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Abstract
Background Optimizing respiratory support after birth requires real-time feedback on lung aeration. We hypothesized that lung ultrasound (LUS) can accurately monitor the extent and progression of lung aeration after birth and is closely associated with oxygenation. Methods Near-term (140 days gestation, term ∼147 days), spontaneously breathing lambs with normal (controls; n = 10) or elevated lung liquid levels (EL; n= 9) were delivered by Caesarean section and monitored for four hours after birth. LUS (Phillips CX50, L3-12 transducer) images and arterial blood gases were taken every 5-20 min. LUS images were analyzed both qualitatively (grading) and quantitatively (using the coefficient of variation of pixel intensity (CoV) to estimate the degree of lung aeration), which was correlated with the oxygen exchange capacity of the lungs (Alveolar-arterial difference in oxygen; AaDO2). Results Lung aeration, measured using LUS, and the AaDO2 improved over the first 4 h after birth. The increase in lung aeration measured using CoV of pixel intensity, but not LUS grade, was significantly reduced in EL lambs compared to controls (p = 0.02). The gradual decrease in AaDO2 after birth was significantly correlated with increased lung aeration in both control (grade, r2 = 0.60, p < 0.0001; CoV, r2 = 0.54, p < 0.0001) and EL lambs (grade, r2 = 0.51, p < 0.0001; CoV, r2 = 0.44, p < 0.0001). Conclusions LUS can monitor lung aeration and liquid clearance after birth in spontaneously breathing near-term lambs. Image analysis techniques (CoV) may be able detect small to moderate differences in lung aeration in conditions with lung liquid retention which are not readily identified using qualitative LUS grading.
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Affiliation(s)
- E. J. Pryor
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - I. M. Davies
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - K. J. Crossley
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - A. M. Thiel
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - E. V. McGillick
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - K Rodgers
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - I Nitsos
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - M. J. Kitchen
- School of Physics and Astronomy, Monash University, Melbourne, VIC, Australia
| | - D. A. Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Monash Newborn, Monash Children’s Hospital, Clayton, VIC, Australia
| | - S. B. Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
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Kellenberger CJ, Lovrenski J, Semple T, Caro-Domínguez P. Neonatal cardiorespiratory imaging-a multimodality state-of-the-art review. Pediatr Radiol 2023; 53:660-676. [PMID: 36138217 DOI: 10.1007/s00247-022-05504-6] [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: 05/20/2022] [Revised: 07/02/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Advanced cardiorespiratory imaging of the chest with ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) plays an important role in diagnosing respiratory and cardiac conditions in neonates when radiography and echocardiography alone are not sufficient. This pictorial essay highlights the particularities, clinical indications and technical aspects of applying chest US, cardiac CT and cardiorespiratory MRI techniques specifically to neonates, summarising the first session of the European Society of Paediatric Radiology's cardiothoracic task force.
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Affiliation(s)
- Christian J Kellenberger
- Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland
- Children's Research Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, University of Novi Sad and Institute for Children and Adolescents Health Care of Vojvodina, Novi Sad, Serbia
| | - Thomas Semple
- Radiology Department, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Pablo Caro-Domínguez
- Pediatric Radiology Unit, Radiology Department, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, Seville, Spain.
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18
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Montero Gato J, Sacristán PA, Vázquez NL, Martín MDLH, Amorós AG, Fernández LR. Incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates. Pediatr Pulmonol 2023; 58:1691-1696. [PMID: 36852449 DOI: 10.1002/ppul.26378] [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: 07/14/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Pneumothorax in neonates can be life-threatening. In neonates without respiratory distress, spontaneous pneumothorax can also develop under certain conditions. OBJECTIVES To determine the incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates using lung ultrasound as the diagnostic tool. METHODS This was an observational prospective study conducted at the Basurto University Hospital (Bilbao, Spain) between January 2018 and December 2020. Lung ultrasound was performed during routine examination of asymptomatic neonates admitted to the maternity ward. RESULTS Of a total of 204 asymptomatic neonates included in the study, 21 (10.3%) presented ultrasound signs of pneumothorax (Group A), and 183 (89.7%) had a normal lung ultrasound (Group B). Lung ultrasound was performed after a mean of 19 h of life (range 9-34). The presence of A-lines behind the sternum in the anterior transverse plane, at the intermammillary level, was observed in 100% of patients in Group A compared to no cases in Group B (p < 0.0001). The neonates of Group A presented the lung point located in the midclavicular line, indicative of a mild air leak. CONCLUSIONS Lung ultrasound allows precise detection of suspected small-sized air leaks that can be detected in asymptomatic neonates. The true incidence of pneumothorax in asymptomatic neonates may be substantially higher than previously described in the literature.
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Affiliation(s)
| | | | | | | | | | - Lorena Rodeño Fernández
- Neonatology Unit, University Hospital Basurto, Bilbao, Spain.,Department of Pediatrics, University of the Basque Country, Bilbao, Spain
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19
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Schwarz S. Pulmonary Sonography - Neonatal Diagnosis Part 1. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:14-35. [PMID: 36075237 DOI: 10.1055/a-1885-5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diseases of the respiratory system are among the main problems of premature patients in the neonatal intensive care unit. Radiography of the thorax is the gold standard of imaging. This results in high cumulative radiation exposure with potential negative long-term consequences. Ultrasound examination of thoracic structures represents a promising radiation-free and ubiquitously available alternative.A healthy, ventilated lung can only be imaged via artifacts, since total reflection of the sound waves occurs due to the high impedance difference between tissue and air-filled lung. Pathologies of pleura and subpleural lung tissue lead to changes in the acoustic properties of the tissue and thus to variations in the artifacts that can be imaged. The main sonographic characteristics of pulmonary pathology are: pleural line abnormalities, increased B-lines and comet-tail artifacts, lung consolidations, a visible pulmonary pulse, pleural sliding abnormalities, and visualization of effusions. Deviations from normal sonographic findings can be assigned to specific underlying pathophysiologies, so that conclusions about the disease can be drawn in conjunction with the clinical symptoms.
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Affiliation(s)
- Simone Schwarz
- Clinic for Pediatrics and Adolescent Medicine, Sana Kliniken Duisburg GmbH, Duisburg, Germany
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20
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Thakur A, Fursule A. Lung ultrasound in neonates - An underused tool. J Med Imaging Radiat Oncol 2023; 67:54-64. [PMID: 36268679 DOI: 10.1111/1754-9485.13485] [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] [Received: 06/16/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
Point of care lung ultrasound (USG) can help in the diagnosis and management of critically sick neonates. It is based on seven simple principles that are comprehensive enough to diagnose all major lung pathologies. A compact small machine and a micro-convex or linear probe are the basic requirements to perform lung USG. In contrast to traditional USG principles, USG of the lung is based on artefacts. Some of the terminologies that are used to characterize normal lung include the pleural line, A-line, bat sign, lung sliding and seashore sign. Air/fluid mixture in varying ratios helps in diagnosis of normal lung, pneumothorax, interstitial syndrome (transient tachypnoea of newborn, respiratory distress syndrome, bronchopulmonary dysplasia), lung consolidation and pleural effusion.
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Affiliation(s)
- Anup Thakur
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Anurag Fursule
- Child and Adolescent Health Services, Perth Children Hospital/King Edward Memorial Hospital, Perth, Western Australia, Australia
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21
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Lung ultrasound score as a predictor of ventilator use in preterm infants with dyspnea within 24 h after dhospitalization. Pediatr Neonatol 2023:S1875-9572(22)00276-5. [PMID: 36732096 DOI: 10.1016/j.pedneo.2022.09.019] [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: 05/30/2022] [Revised: 08/02/2022] [Accepted: 09/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Selecting the correct ventilation strategy is crucial for the survival of preterm infants with dyspnea in NICU. Lung ultrasound score (LUSsc) is a potential predictor for respiratory support patterns in preterm infants. METHODS We prospectively included 857 preterm infants. LUS was performed in the first 2 h after admission, and LUSsc was determined by two specialist sonographers. Participants were divided into two categories according to gestational age (<32+0 weeks and 32+0-36+6 weeks) and randomly divided into a training set and a validation set. There were two main outcomes: invasive and non-invasive respiratory support. In the training set, clinical factors were analyzed to find the best cut-off value of LUSsc, and consistency was verified in the verification set. The choice of invasive respiratory support was based on neonatal mechanical ventilation strategies. RESULTS Preterm infants with invasive respiratory support had a higher LUSsc, greater use of Pulmonary Surfactant(PS), and lower Oxygenation Index(OI)、birth weight than those with non-invasive support. In the <32+0 weeks group, the area under the curve (AUC) for the receiver operating characteristic curve plotted with 2-h LUSsc was 0.749 (95% CI: 0.689-0.809), the cut-off point of LUSsc was 8, and the sensitivity and specificity were 74.0% and 68.3%, respectively. In the 32+0-36+6 weeks group, the AUC was 0.863 (95% CI: 0.811-0.911), with a cut-off point of 7. Sensitivity and specificity were 75.3% and 0.836%, respectively. In the validation set, using the actual clinical respiratory support selection results for verification, the validation results showed for the <32+0 weeks group (Kappa value 0.660, P < 0.05, McNemar test P > 0.05) for preterm 32+0-36+6 weeks (Kappa value 0.779, P < 0.05, McNemar test P > 0.05). CONCLUSION The LUSsc showed good reliability in predicting respiratory support mode for preterm infants with dyspnea. Registered at ClinicalTrials.gov (identifier: chiCTR1900023869).
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22
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Parri N, Allinovi M, Giacalone M, Corsini I. To B or not to B. The rationale for quantifying B-lines in pediatric lung diseases. Pediatr Pulmonol 2023; 58:9-15. [PMID: 36253340 DOI: 10.1002/ppul.26185] [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: 11/11/2021] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
Lung ultrasound (LUS) is emerging as adjunct tool to be used during clinical assessment. Among the different hallmarks of LUS, B-lines are well known artifacts, which are not correlated with identifiable structures, but which can be used for pathological classification. The presence of multiple B-lines is a sonographic sign of lung interstitial syndrome. It has been demonstrated in adults that there is a direct correlation between the number of B-lines and the severity of the interstitial involvement of lung disease. Counting B-lines is an attempt to enrich the clinical assessment and clinical information, beyond obtaining a simple dichotomous answer. Semiquantitative or quantitative B-line assessment has been shown to correlate with fluid overload and demonstrated prognostic implications in specific neonatal and pediatric conditions. LUS with quantitative B-lines assessment is promising. Current evidence allows for quantification of B-lines in a limited number of neonatal and pediatric diseases.
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Affiliation(s)
- Niccolò Parri
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy
| | - Martina Giacalone
- Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
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23
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Sett A, Kenna KR, Sutton RJ, Perkins EJ, Sourial M, Chapman JD, Donath SM, Sasi A, Rogerson SR, Manley BJ, Davis PG, Pereira-Fantini PM, Tingay DG. Lung ultrasound of the dependent lung detects real-time changes in lung volume in the preterm lamb. Arch Dis Child Fetal Neonatal Ed 2023; 108:51-56. [PMID: 35750468 PMCID: PMC9763221 DOI: 10.1136/archdischild-2022-323900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/03/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Effective lung protective ventilation requires reliable, real-time estimation of lung volume at the bedside. Neonatal clinicians lack a readily available imaging tool for this purpose. OBJECTIVE To determine the ability of lung ultrasound (LUS) of the dependent region to detect real-time changes in lung volume, identify opening and closing pressures of the lung, and detect pulmonary hysteresis. METHODS LUS was performed on preterm lambs (n=20) during in vivo mapping of the pressure-volume relationship of the respiratory system using the super-syringe method. Electrical impedance tomography was used to derive regional lung volumes. Images were blindly graded using an expanded scoring system. The scores were compared with total and regional lung volumes, and differences in LUS scores between pressure increments were calculated. RESULTS Changes in LUS scores correlated moderately with changes in total lung volume (r=0.56, 95% CI 0.47-0.64, p<0.0001) and fairly with right whole (r=0.41, CI 0.30-0.51, p<0.0001), ventral (r=0.39, CI 0.28-0.49, p<0.0001), central (r=0.41, CI 0.31-0.52, p<0.0001) and dorsal (r=0.38, CI 0.27-0.49, p<0.0001) regional lung volumes. The pressure-volume relationship of the lung exhibited hysteresis in all lambs. LUS was able to detect hysteresis in 17 (85%) lambs. The greatest changes in LUS scores occurred at the opening and closing pressures. CONCLUSION LUS was able to detect large changes in total and regional lung volume in real time and correctly identified opening and closing pressures but lacked the precision to detect small changes in lung volume. Further work is needed to improve precision prior to translation to clinical practice.
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Affiliation(s)
- Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia .,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kelly R Kenna
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rebecca J Sutton
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Translational Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Magdy Sourial
- Translational Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jack D Chapman
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Donath
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Arun Sasi
- Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia,Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Brett J Manley
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia,Department of Neonatology, The Royal Children's Hospital, Melbourne, Victoria, Australia
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24
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Stewart DL, Elsayed Y, Fraga MV, Coley BD, Annam A, Milla SS. Use of Point-of-Care Ultrasonography in the NICU for Diagnostic and Procedural Purposes. Pediatrics 2022; 150:190110. [PMID: 37154781 DOI: 10.1542/peds.2022-060053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) refers to the use of portable imaging performed by the provider clinician at the bedside for diagnostic, therapeutic, and procedural purposes. POCUS could be considered an extension of the physical examination but not a substitute for diagnostic imaging. Use of POCUS in emergency situations can be lifesaving in the NICU if performed in a timely fashion for cardiac tamponade, pleural effusions, pneumothorax, etc, with potential for enhancing quality of care and improving outcomes.
In the past 2 decades, POCUS has gained significant acceptance in clinical medicine in many parts of the world and in many subspecialties. Formal accredited training and certification programs are available for neonatology trainees as well as for many other subspecialties in Canada, Australia, and New Zealand. Although no formal training program or certification is available to neonatologists in Europe, POCUS is widely available to providers in NICUs. A formal institutional POCUS fellowship is now available in Canada. In the United States, many clinicians have the skills to perform POCUS and have incorporated it in their daily clinical practice. However, appropriate equipment remains limited, and many barriers exist to POCUS program implementation.
Recently, the first international evidence-based POCUS guidelines for use in neonatology and pediatric critical care were published. Considering the potential benefits, a recent national survey of neonatologists confirmed that the majority of clinicians were inclined to adopt POCUS in their clinical practice if the barriers could be resolved.
This technical report describes many potential POCUS applications in the NICU for diagnostic and procedural purposes.
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Affiliation(s)
- Dan L Stewart
- Department of Pediatrics and International Pediatrics, Norton Children's Neonatology Affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Yasser Elsayed
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba-Canada, Health Sciences Centre-Winnipeg, Winnipeg, Manitoba, Canada
| | - María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian D Coley
- Departments of Radiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Aparna Annam
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Vascular Anomalies Center, Aurora, Colorado
| | - Sarah Sarvis Milla
- Departments of Radiology and Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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25
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Zhang X, Zhang N, Ren YY. Review of risk factors, clinical manifestations, rapid diagnosis, and emergency treatment of neonatal perioperative pneumothorax. World J Clin Cases 2022; 10:12066-12076. [PMID: 36483838 PMCID: PMC9724522 DOI: 10.12998/wjcc.v10.i33.12066] [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: 07/16/2022] [Revised: 09/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
Perioperative neonatal pneumothorax (NP) is rare but very fatal. Most of the surgeries and treatments in the neonatal period are time-limited or emergent, and there are often some risk factors for pneumothorax before surgery. Physicians, surgeons and anesthesiologists need to identify possible risk factors for pneumothorax before surgery in preterm babies, patients receiving mechanical ventilation and those with underlying lung disease. The clinical presentation of NP is nonspecific, and patients may rapidly develop life-threatening complications if not promptly diagnosed and managed. This review highlights recent progress in the identification of risk factors, clinical manifestations, diagnosis and management of NP during the perioperative period.
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Affiliation(s)
- Xu Zhang
- Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Ning Zhang
- Department of Clinical Laboratory, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
| | - Yue-Yi Ren
- Department of Heart Center, Women's and Children's Hospital Affiliated to Qingdao University, Qingdao 266034, Shandong Province, China
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26
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Rodriguez-Fanjul J, Corsini I, Ortí CS, Bobillo-Perez S, Raimondi F. Lung ultrasound to evaluate lung recruitment in neonates with respiratory distress (RELUS study). Pediatr Pulmonol 2022; 57:2502-2510. [PMID: 35792663 DOI: 10.1002/ppul.26066] [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: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is a bedside tool useful to diagnose neonatal respiratory disease and to guide surfactant therapy. LUS scores have emerged as useful tool for newborn respiratory distress but is unknown if respiratory support settings may influence it. The aim of the study was to evaluate the feasibility of LUS scores evaluating lung recruitment in term newborns with respiratory distress when noninvasive respiratory it is increased. MATERIAL AND METHODS Prospective study in a tertiary neonatal intensive care unit. Inclusion criteria were term neonates with respiratory distress requiring noninvasive respiratory support with nasal continuous positive airway pressure (nCPAP) within first 6 h of life with an LUS score higher than 8 were enrolled. LUS was performed three times. First LUS (LUS-1) was done in patients in nCPAP (Fabian Device) (Acutronic) (pressure of 6 cmH2 O). Afterwards patients were placed in duo positive airway pressure (12/6 cmH2 O), a second LUS (LUS-2) was performed immediately and a third (LUS-3) was done 2 h later on the same respiratory support. The primary outcome was to compare LUS scores in the different timelines. Second outcomes were to evaluate the level of respiratory distress and oxygenation were evaluated with SpO2 /fraction of inspired oxygen (FiO2 ) ratio (S/F ratio), FiO2 ratio, respiratory rate, and blood gas analysis which were analyzed during the LUS-1 and the LUS-3. To evaluate newborn discomfort, patients were evaluated with Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale. RESULTS Forty neonates were enrolled. Fifty percent were female (n = 20), median gestational age was 38 + 4 (interquartile range [IQR]: 37 + 5-39 + 4) with a median weight of 3155 g (IQR: 2637-3532). Duration of non invasive ventilation support was 72 h (IQR: 54-96). None of the patients required surfactant therapy or mechanical ventilation. LUS scores were no different between LUS-1 9 (IQR: 8.3-10) and LUS-2 9 (IQR: 8.3-10) (p = 0.675) but there were differences between LUS-1 and LUS-3 7 (IQR: 6.3-8.5) (p = 0.036). There was an improvement in the oxygen parameters, respiratory rate, and CO2 between LUS-1 and LUS-3 (p < 0.001). There were no changes in the CRIES scale. CONCLUSIONS There is an improvement in clinical and laboratory parameters after the increasing of respiratory support in newborns with noninvasive ventilation. We observe a correlation with an improvement in the assessment of lung aeration were evaluated with LUS score.
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Affiliation(s)
- Javier Rodriguez-Fanjul
- Neonatal Intensive Care Unit, Paediatric Department, Hospital Germans Trias i Pujol, Badalona, Spain.,Institut d'Investigació Germans Trias I Pujol, Badalona, Spain
| | - Iuri Corsini
- Neonatology Division, Careggi University Hospital of Florence, Florence, Italy
| | - Clara Sorribes Ortí
- Neonatal Intensive Care Unit, Paediatric Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Care Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Francesco Raimondi
- Department of Translational Medical Sciences, Neonatology Division, Università "Federico II", Napoli, Italy
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27
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Marzook N, Gagnon F, Deragon A, Zielinski D, Shapiro AJ, Lands LC, Dubrovsky AS. Lung ultrasound findings in asymptomatic healthy children with asthma. Pediatr Pulmonol 2022; 57:2474-2480. [PMID: 35794853 DOI: 10.1002/ppul.26061] [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: 12/14/2021] [Revised: 06/13/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress. However, very little is known about LUS findings in pediatric asthma. OBJECTIVES The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. METHODS Eligible patients, aged 6-17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. Presence of a LUS artifact was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation, and/or pleural abnormality. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. RESULTS Fifty-two patients were included. 10/52 (19.2%) patients demonstrated the presence of LUS artifacts: 8 with ≥3 B-lines, 1 with consolidation >1 cm, and 7 with subpleural consolidations <1 cm, 1 with a pleural line abnormality. Artifacts were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal space(s) within one lung zone in all participants. No association was found between presence of LUS artifacts and asthma control or severity. CONCLUSION To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. LUS artifacts in asthmatic children can be seen outside of acute exacerbations. Such baseline findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.
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Affiliation(s)
- Noah Marzook
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Francois Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | - David Zielinski
- Pediatric Respirology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Adam J Shapiro
- Pediatric Respirology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Larry C Lands
- Pediatric Respirology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Alexander S Dubrovsky
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.,UP Centre for Pediatric Emergencies, Montreal, Quebec, Canada
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28
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Sett A, Foo GWC, Kenna KR, Sutton RJ, Perkins EJ, Sourial M, Rogerson SR, Manley BJ, Davis PG, Pereira-Fantini PM, Tingay DG. Quantitative lung ultrasound detects dynamic changes in lung recruitment in the preterm lamb. Pediatr Res 2022; 93:1591-1598. [PMID: 36167816 PMCID: PMC10172106 DOI: 10.1038/s41390-022-02316-0] [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: 07/11/2022] [Revised: 08/24/2022] [Accepted: 09/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) may not detect small, dynamic changes in lung volume. Mean greyscale measurement using computer-assisted image analysis (Q-LUSMGV) may improve the precision of these measurements. METHODS Preterm lambs (n = 40) underwent LUS of the dependent or non-dependent lung during static pressure-volume curve mapping. Total and regional lung volumes were determined using the super-syringe technique and electrical impedance tomography. Q-LUSMGV and gold standard measurements of lung volume were compared in 520 images. RESULTS Dependent Q-LUSMGV moderately correlated with total lung volume (rho = 0.60, 95% CI 0.51-0.67) and fairly with right whole (rho = 0.39, 0.27-0.49), central (rho = 0.38, 0.27-0.48), ventral (rho = 0.41, 0.31-0.51) and dorsal regional lung volumes (rho = 0.32, 0.21-0.43). Non-dependent Q-LUSMGV moderately correlated with total lung volume (rho = 0.57, 0.48-0.65) and fairly with right whole (rho = 0.43, 0.32-0.52), central (rho = 0.46, 0.35-0.55), ventral (rho = 0.36, 0.25-0.47) and dorsal lung volumes (rho = 0.36, 0.25-0.47). All correlation coefficients were statistically significant. Distinct inflation and deflation limbs, and sonographic pulmonary hysteresis occurred in 95% of lambs. The greatest changes in Q-LUSMGV occurred at the opening and closing pressures. CONCLUSION Q-LUSMGV detected changes in total and regional lung volume and offers objective quantification of LUS images, and may improve bedside discrimination of real-time changes in lung volume. IMPACT Lung ultrasound (LUS) offers continuous, radiation-free imaging that may play a role in assessing lung recruitment but may not detect small changes in lung volume. Mean greyscale image analysis using computer-assisted quantitative LUS (Q-LUSMGV) moderately correlated with changes in total and regional lung volume. Q-LUSMGV identified opening and closing pressure and pulmonary hysteresis in 95% of lambs. Computer-assisted image analysis may enhance LUS estimation of lung recruitment at the bedside. Future research should focus on improving precision prior to clinical translation.
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Affiliation(s)
- Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia. .,Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia. .,Joan Kirner Women's and Children's Hospital, Western Health, St Albans, VIC, Australia. .,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia. .,Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, VIC, Australia.
| | - Gillian W C Foo
- Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Kelly R Kenna
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Rebecca J Sutton
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Translational Research Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Magdy Sourial
- Translational Research Unit, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia.,Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Brett J Manley
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia
| | - Peter G Davis
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, VIC, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Newborn Research Centre, The Royal Women's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Neonatology, The Royal Children's Hospital, Parkville, VIC, Australia
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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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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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Gao YQ, Qiu RX, Liu J, Zhang L, Ren XL, Qin SJ. Lung ultrasound completely replaced chest X-ray for diagnosing neonatal lung diseases: a 3-year clinical practice report from a neonatal intensive care unit in China. J Matern Fetal Neonatal Med 2022; 35:3565-3572. [PMID: 33032479 DOI: 10.1080/14767058.2020.1830369] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Lung ultrasound (LUS) has been widely used in the diagnosis and differential diagnosis of neonatal lung diseases (NLDs), but whether it can replace the routine use of chest X-ray (CXR) in neonatal intensive care units (NICUs) remains controversial. This paper summarizes the clinical practice of our neonatal intensive care unit (NICU) during the past three years to explore the feasibility and necessity of using LUS instead of CXR to diagnose NLDs in the NICU setting. METHODS The clinical data and LUS examination results from 1,381 newborn infants with respiratory difficulty who were hospitalized in our NICU from March 2017 to February 2020 were retrospectively collected to analyze the types of lung diseases diagnosed and the reliability of LUS for diagnosing NLDs. RESULTS (1) During this period, 1381 newborn infants with dyspnea were admitted to our NICU, accounting for 41.2% of all hospitalized children. (2) Among the 1381 infants, 17 patients with respiratory distress were confirmed as having severe heart disease by echocardiography, while the remaining 1364 patients had different kinds of lung diseases: pneumonia (697 patients, 51.1%), respiratory distress syndrome (251 patients, 17.4%), transient tachypnea of the newborn (197 patients, 13.3%), atelectasis (89 patients, 5.6%), pneumothorax (46 patients, 3.2%), pulmonary hemorrhage (69 patients, 4.5%), severe pleural effusion (18 patients, 1.32%), congenital pulmonary sequestration (3 patients, 0.22%), bullae of the lung (2 patients, 0.15%), and congenital cystic adenomatoid malformation (2 patients). (5) Among the 1381 infants, 217 received CXR examination before admission, which resulted in misdiagnosis in 45 patients (20.7%) and missed diagnosis in 12 patients (5.5%); the missed diagnosis and misdiagnosis rate was 26.3%. CONCLUSION Our 3-year clinical practice experience indicated that LUS could completely replace chest X-ray for the diagnosis and differential diagnosis of NLDs in the NICU. Compared with X-ray, LUS had higher accuracy and reliability in diagnosing NLDs.
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Affiliation(s)
- Yue-Qiao Gao
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The Neonatal Lung Ultrasound Training Base, Beijing, China
| | - Ru-Xin Qiu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The Neonatal Lung Ultrasound Training Base, Beijing, China
| | - Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The Neonatal Lung Ultrasound Training Base, Beijing, China
| | - Li Zhang
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The Neonatal Lung Ultrasound Training Base, Beijing, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The Neonatal Lung Ultrasound Training Base, Beijing, China
| | - Sheng-Juan Qin
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The Neonatal Lung Ultrasound Training Base, Beijing, China
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Perri A, Sbordone A, Patti ML, Nobile S, Tirone C, Giordano L, Tana M, D'Andrea V, Priolo F, Serrao F, Riccardi R, Prontera G, Maddaloni C, Lenkowicz J, Boldrini L, Vento G. Early lung ultrasound score to predict noninvasive ventilation needing in neonates from 33 weeks of gestational age: A multicentric study. Pediatr Pulmonol 2022; 57:2227-2236. [PMID: 35670034 DOI: 10.1002/ppul.26031] [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: 03/01/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To propose an early lung ultrasound (LUS) score for the prediction of the need for respiratory assistance in newborns of gestational age (GA) ≥ 33 weeks presenting respiratory distress. STUDY DESIGN AND SETTING Multicenter, prospective observational study in third-level neonatal intensive care units. PATIENT SELECTION Infants with GA ≥ 33 + 0 weeks with respiratory distress within 3 h of life. METHODS Three LUS for each patient were collected: within 3 h of life (T0), at 4-6 h of life (T1), and at the resolution of symptoms (T2). The primary aim was to assess the validity of the early LUS score in predicting the need for continuous positive airway pressure (CPAP). We also evaluated the validity of the score in predicting the need for surfactant, the scores' trend in our population, and any correlation with the duration of ventilation and oxygen therapy. RESULTS Sixty-two patients were enrolled in the study. The mean GA was 36 weeks. The receiver operating characteristic analysis for the LUS T0 and T1 yielded area under the curves of 0.91 and 0.82 in predicting the need for CPAP, respectively. LUS score cut off of 6 (sensitivity 84.8%, specificity 86.2%) and 5 (sensitivity 66.7%, specificity 100%) were calculated at T0 and T1, respectively. We found significant correlations between LUS score and respiratory assistance, surfactant administration, and SpO2 /FiO2 ratio. CONCLUSION An early LUS score is a good noninvasive predictor of the need for respiratory assistance with CPAP and surfactant administration in newborns with GA ≥ 33 weeks.
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Affiliation(s)
- Alessandro Perri
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Annamaria Sbordone
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Maria L Patti
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Stefano Nobile
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Chiara Tirone
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Lucia Giordano
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Milena Tana
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Vito D'Andrea
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Francesca Priolo
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Francesca Serrao
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Riccardo Riccardi
- Neonatal Intensive Care Unit, "San Giovanni Calibita Fatebenefratelli" Hospital, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy
| | - Chiara Maddaloni
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus, Newborn and Infant, "Bambino Gesù" Children's Hospital IRCSS, Rome, Italy
| | - Jacopo Lenkowicz
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Luca Boldrini
- Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health Sciences, Child Health Area, University Hospital Agostino Gemelli, Rome, Italy.,Department of Woman and Child Health Sciences, Child Health Area, Catholic University of Sacred Heart, Rome, Italy
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Semi-quantitative lung ultrasound score during ground transportation of outborn neonates with respiratory failure. Eur J Pediatr 2022; 181:3085-3092. [PMID: 35697797 DOI: 10.1007/s00431-022-04488-7] [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: 02/10/2022] [Revised: 03/30/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Lung ultrasound score (LUS) is increasingly diffused in neonatal critical care but scanty data are available about its use during transfer of severely ill neonates. We aimed to clarify the effect of ground transportation on LUS evolution, conformity of interpretation, and relationships with oxygenation and clinical severity. This is a single-center, blinded, observational, cross-sectional study. Neonates of any gestational age with respiratory distress appearing within 24 h from birth were transferred by a mobile unit towards neonatal intensive care unit (NICU) of a tertiary referral center. Calculation of LUS prior to the transportation (T1), in the mobile unit (T2), at the end of transportation (T3), and finally upon NICU admission. LUS in the mobile unit and in the NICU was performed by different physicians blinded to each other's results. LUS did not change overtime (T1: 6.3 (3.5), T2: 6.1 (3.5), T3: 5.8 (3.4); p = 0.479; adjusted for gestational or postnatal age or transport duration: p = 0.951, p = 0.424, and 0.266, respectively) but reliably predicted surfactant need (AUC at T1: 0.833 (95%CI: 0.72-0.92); AUC at T2: 0.82 (95%CI: 0.70-0.91); AUC at T3: 0.82 (95%CI: 0.70-0.90); p always < 0.0001). There were significant agreement (ICC = 0.912 (95%CI: 0.83-0.95); p < 0.001) and correlation (r = 0.905, p < 0.001) between LUS calculated during transportation and in the NICU. LUS during transportation was also significantly correlated with oxygenation index (r = 0.321, p = 0.026; standardized B = 0.397 (95%CI: 0.03-0.76), p = 0.048) and TRIPS-II score (r = 0.302, p = 0.008; standardized B = 0.568 (95%CI: 0.04-1.1), p = 0.037). CONCLUSION LUS during ground transportation of neonates with respiratory failure is suitable and not influenced by the transportation itself. It has a high agreement with that calculated in the NICU and correlates with patients' oxygenation and severity. WHAT IS KNOWN • Lung ultrasound is a part of the point-of-care ultrasound, which is becoming an essential tool, to manage critically ill neonates and children in an accurate, non-invasive and quick way. WHAT IS NEW • Lung ultrasound score (LUS) is suitable during transportation of critically ill neonates with respiratory failure and is not influenced by the transportation itself. • LUS has a high agreement with that calculated in the NICU and correlates with patients' oxygenation and severity of respiratory failure.
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Gagnon F, Marzook N, Deragon A, Lands LC, Zielinski D, Shapiro AJ, Rampakakis E, Dubrovsky AS. Characterizing pediatric lung ultrasound findings during a chemically induced bronchospasm. Pediatr Pulmonol 2022; 57:1475-1482. [PMID: 35355448 DOI: 10.1002/ppul.25907] [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: 06/04/2021] [Revised: 01/20/2022] [Accepted: 03/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) has been shown to be a useful clinical tool in pediatrics, but very little is known about the LUS findings of asthma in children. OBJECTIVES The primary objective was to characterize LUS findings of pediatric patients before and after a chemically induced bronchospasm. The secondary objective was to evaluate the effect of bronchodilators on LUS findings. METHODS Eligible children 6-17 years old presenting for a methacholine challenge test (MCT) in a pediatric respiratory clinic were recruited. Patients with viral symptoms were excluded. A six-zone LUS protocol was performed before and after the MCT, and after bronchodilator administration; video recordings were analysed by an expert blinded to the patient characteristics and MCT results. RESULTS Forty-four patients were included in the study. Five patients had positive LUS findings at baseline. Nine patients out of 29 (31%) had new-onset positive LUS following a reactive MCT. There was a significant association between having a chemically induced bronchospasm and a positive LUS post-MCT (odds ratio [95% confidence interval]: 5.3 [1.0-27.7]; p = 0.05). Among patients who developed positive LUS findings post-MCT, four out of nine returned to having a negative LUS postbronchodilator administration. CONCLUSIONS This is the first known report of an association between LUS findings and bronchospasm in pediatric patients. It is also the first documentation of resolution of LUS findings postbronchodilator administration. Most LUS findings observed were small and limited to a few intercostal spaces. Further research is required to quantify these findings and evaluate the effect of salbutamol on LUS.
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Affiliation(s)
- Francois Gagnon
- McGill University Health Center, Division of General Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Noah Marzook
- McGill University Health Center, Division of General Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Alexandre Deragon
- Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ontario, Ottawa, Canada
| | - Larry C Lands
- Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - David Zielinski
- Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Adam J Shapiro
- Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Emmanouil Rampakakis
- McGill University Health Center, Division of General Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Alexander S Dubrovsky
- Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure. J Ultrasound 2022; 25:929-937. [PMID: 35397743 PMCID: PMC8994848 DOI: 10.1007/s40477-022-00675-2] [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: 12/10/2021] [Accepted: 03/05/2022] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To describe point-of-care lung ultrasound (POC-LUS) artifact findings in children admitted to the pediatric intensive care unit (PICU) for acute respiratory failure (ARF). METHODS This is a secondary analysis of a prospective observational study completed in a 21-bed PICU. Children > 37 weeks gestational age and ≤ 18 years were enrolled from December 2018 to February 2020. POC-LUS was completed and interpreted by separate physicians blinded to all clinical information. POC-LUS was evaluated for the presence of lung sliding, pleural line characteristics, ultrasound artifacts, and the ultrasound diagnosis. RESULTS Eighty-seven subjects were included. A-lines were the most frequent artifact, occurring in 58% of lung zones (163/281) in those with bronchiolitis, 39% of lung zones (64/164) in those with pneumonia, and 81% of lung zones (48/59) in those with status asthmaticus. Sub-pleural consolidation was second most common, occurring in 28% (80/281), 30% (50/164), and 12% (7/59) of those with bronchiolitis, pneumonia, and status asthmaticus, respectively. The pattern a priori defined as bronchiolitis, pneumonia, and status asthmaticus was demonstrated in 31% (15/48), 10% (3/29), and 40% (4/10) of subjects with bronchiolitis, pneumonia, and status asthmaticus, respectively. CONCLUSION We found significant heterogeneity and overlap of POC-LUS artifacts across the most common etiologies of ARF in children admitted to the PICU. We have described the POC-LUS artifact findings in pediatric ARF to support clinicians using POC-LUS and to guide future pediatric POC-LUS studies. Determining the optimal role of POC-LUS as an adjunct in the care of pediatric patients requires further study.
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Gregorio-Hernández R, Pérez-Pérez A, Alonso-Ojembarrena A, Arriaga-Redondo M, Ramos-Navarro C, Sánchez-Luna M. Neonatal pneumothoraces with atypical location: the role of lung ultrasound. Eur J Pediatr 2022; 181:1751-1756. [PMID: 34845527 DOI: 10.1007/s00431-021-04329-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/02/2023]
Abstract
UNLABELLED Neonatal pneumothorax (NP) is a potentially life-threatening condition. Lung ultrasound (LUS) has shown higher sensitivity and specificity in diagnosis compared to x-rays, but evidence regarding its usefulness in complex NP is lacking. We report four neonates suffering from cardiac or esophageal malformations who developed lateral and/or posterior pneumothoraces, in which LUS helped, making NP diagnosis and management easier and faster. CONCLUSION LUS is an easy-to-use, fast, simple, and accurate tool when evaluating newborns with NP, also in atypical positions such as in surgical patients. WHAT IS KNOWN • Lung ultrasound (LUS) has higher sensitivity and specificity than x-rays in the diagnosis of pneumothorax in neonatal patients. WHAT IS NEW • This is the first report about neonatal pneumothorax in non-conventional areas (lateral/posterior) diagnosed by lung ultrasound and how obtaining this information is critical in order to optimize management.
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Affiliation(s)
| | - Alba Pérez-Pérez
- Neonatology Department, Gregorio Marañón University Hospital, Madrid, Spain
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Tognon C, Pulvirenti R, Pizzi S, Zuliani M, Cortese G, Esposito C, Gamba P. Lung Ultrasound to Assess One Lung Ventilation: A Pediatric Case Series. J Laparoendosc Adv Surg Tech A 2022; 32:566-570. [PMID: 35353608 DOI: 10.1089/lap.2021.0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: One lung ventilation (OLV) is the preferred ventilation technique for thoracoscopy as it provides a better exposure of the operative field and grants the protection of the healthy lung. Preoperative evaluation of lung exclusion is necessary and different methods are available. In recent years lung ultrasound (US) gained popularity and its use for monitoring the endotracheal tube position is widely reported. The existing evidence on adults addresses lung US as effective, yet only few data are available in children. Therefore, we present our experience with lung US as verification method for pediatric OLV. Methods: All patients undergoing OLV for video-assisted thoracoscopic surgery from January 2019 to May 2021 and for whom lung exclusion was confirmed through lung US were involved. Lung exclusion was considered effective when absence of lung motion and presence of lung pulse were encountered. When lung US did not match these criteria, repositioning of the endobronchial device followed by US verification was performed. When lung US met the exclusion criteria surgery was started and direct thoracoscopic observation was used to verify lung exclusion. Results: A total of 20 patients, accounting for 22 procedures, were involved. Absence of lung motion and presence of lung pulse were assessed in the operative-side lung for all patients. Lung exclusion was confirmed through thoracoscopy. Postoperative lung US proved the reappearance of lung motion in the previously excluded lung. Conclusions: In our center experience lung US resulted to be a safe, effective, and time-saving verification method for OLV. Further studies are needed to define its sensitivity and specificity.
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Affiliation(s)
- Costanza Tognon
- Anesthesiology Pediatric Unit, Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Rebecca Pulvirenti
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Simone Pizzi
- Anesthesiology Pediatric Unit, Mother and Child Department, G. Salesi Hospital, Ancona, Italy
| | - Monica Zuliani
- Department of Medicine, Pediatric Radiology Unit-Radiology Institute Hospital, University of Padova, Padova, Italy
| | - Giuseppe Cortese
- Unit of Anesthesia, Intensive Care and Pain Therapy, Department of General and Specialistic Surgery, Kidney Transplantation, Nephrology, Intensive Care and Pain Therapy, Federico II University of Naples, Naples, Italy
| | - Ciro Esposito
- Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University of Padova, Padova, Italy
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Liu J, Guo G, Kurepa D, Volpicelli G, Sorantin E, Lovrenski J, Alonso-Ojembarrena A, Hsieh KS, Lodha A, Yeh TF, Jagła M, Shah H, Yan W, Hu CB, Zhou XG, Guo RJ, Cao HY, Wang Y, Zong HF, Shang LL, Ma HR, Liu Y, Fu W, Shan RY, Qiu RX, Ren XL, Copetti R, Rodriguez-Fanjul J, Feletti F. Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination. J Matern Fetal Neonatal Med 2022; 35:1003-1016. [PMID: 34182870 DOI: 10.1080/14767058.2021.1940943] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung ultrasound (LUS) is now widely used in the diagnosis and monitor of neonatal lung diseases. Nevertheless, in the published literatures, the LUS images may display a significant variation in technical execution, while scanning parameters may influence diagnostic accuracy. The inter- and intra-observer reliabilities of ultrasound exam have been extensively studied in general and in LUS. As expected, the reliability declines in the hands of novices when they perform the point-of-care ultrasound (POC US). Consequently, having appropriate guidelines regarding to technical aspects of neonatal LUS exam is very important especially because diagnosis is mainly based on interpretation of artifacts produced by the pleural line and the lungs. The present work aimed to create an instrument operation specification and parameter setting guidelines for neonatal LUS. Technical aspects and scanning parameter settings that allow for standardization in obtaining LUS images include (1) select a high-end equipment with high-frequency linear array transducer (12-14 MHz). (2) Choose preset suitable for lung examination or small organs. (3) Keep the probe perpendicular to the ribs or parallel to the intercostal space. (4) Set the scanning depth at 4-5 cm. (5) Set 1-2 focal zones and adjust them close to the pleural line. (6) Use fundamental frequency with speckle reduction 2-3 or similar techniques. (7) Turn off spatial compounding imaging. (8) Adjust the time-gain compensation to get uniform image from the near-to far-field.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Guo Guo
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
- Department of Neonatology, The Fifth Medical Center of Chinese of PLA General Hospital, Beijing, China
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New York, NY, USA
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Shuangho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Abhay Lodha
- Department of Pediatrics & Community Health Sciences, University of Calgary, Foothills Medical Centre, Calgary, NW, Canada
| | - Tsu F Yeh
- Division of Neonatology, Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
| | - Mateusz Jagła
- Department of Pediatrics, University Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Heli Shah
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New York, NY, USA
| | - Wei Yan
- Department of Ultrasound, Zhumadian Center Hospital, Zhumadian City, China
| | - Cai-Bao Hu
- Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
| | - Xiao-Guang Zhou
- Neonatal Medical Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Rui-Jun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hai-Ying Cao
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Yan Wang
- Department of Neonatology and NICU, Tai'an Central Hospital of Shandong Province, Taian City, China
| | - Hai-Feng Zong
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Li-Li Shang
- Department of Neonatology and NICU, Huizhou Central Hospital of Guangdong Province, Huizhou City, China
| | - Hai-Ran Ma
- Department of Intensive Care Unit, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Haerbin, China
| | - Ying Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Rui-Yan Shan
- Department of Neonatology, Yantai Yuhuangding Hospital Affiliated to Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Ru-Xin Qiu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Roberto Copetti
- Department of Emergency, University Hospital of Cattinara, Trieste, Italy
| | | | - Francesco Feletti
- Unit of Radiology, Ospedale S. Maria delle Croci Ravenna, Ausl Romagna, Ravenna, Italy
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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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40
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Tandircioglu UA, Yigit S, Oguz B, Kayki G, Celik HT, Yurdakok M. Lung ultrasonography decreases radiation exposure in newborns with respiratory distress: a retrospective cohort study. Eur J Pediatr 2022; 181:1029-1035. [PMID: 34687334 DOI: 10.1007/s00431-021-04296-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 01/22/2023]
Abstract
Chest X-ray (CXR) is commonly used as a first-line imaging method to determine the cause of respiratory distress in NICUs. The aim of the study was to retrospectively assess the decrease in the number of CXRs performed due to the use of lung ultrasonography on the first day of life for newborns with respiratory distress. Infants who were admitted to the NICU on the first day of life due to respiratory distress were enrolled in this study (ClinicalTrials.gov identifier NCT04722016) and divided into two groups: the study group (n = 104) included patients born between January 2019 and June 2020, and the historical control group (n = 73) included patients born between June 2017 and December 2018. As a first-line technique for lung imaging, only CXR had been used in the historical control group, whereas ultrasound had been preferred in the study group. The radiation dose to the newborns and the number of CXRs performed in the first day of life were compared between the two groups. Significant reductions in the number of CXRs performed and radiation exposure were observed in the study group. The radiation dose decreased from 5.54 to 4.47 µGy per baby when LUS was routinely used. The proportion of patients who underwent CXR decreased from 100 to 71.2%.Conclusion: We observed that using lung ultrasonography as a first-line evaluation method in neonates with respiratory distress decreased both the number of CXRs performed and radiation exposure. What is Known: • Chest X-ray is commonly used as a first line imaging method to diagnose the reason of respiratory distress in NICUs. • Lung ultrasound is a new diagnostic tool for lung imaging. What is New: • With the use of lung ultrasonography, radiation exposure of both newborns and healthcare workers can be reduced. • This retrospective study revealed that most of the babies with respiratory distress were treated without CXR.
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Affiliation(s)
- Umit Ayşe Tandircioglu
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey.
| | - Sule Yigit
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Gozdem Kayki
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Hasan Tolga Celik
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Murat Yurdakok
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
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41
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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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43
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Burton L, Bhargava V, Kong M. Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. Front Pediatr 2022; 9:830160. [PMID: 35178366 PMCID: PMC8845897 DOI: 10.3389/fped.2021.830160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022] Open
Abstract
Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.
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Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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45
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Prontera G, Perri A, Vento G, D'Andrea V. Use of Wireless Ultrasound Probe in Isolated Infants: A Case Report of Two SARS-CoV-2-Positive Mothers' Newborns. Neonatology 2022; 119:129-132. [PMID: 34784600 PMCID: PMC8678242 DOI: 10.1159/000519712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 01/22/2023]
Abstract
The COVID-19 pandemic has upset habits in any workplace. In hospitals, several precautions have been taken to maintain health-care workers' safety and to avoid disease spread or the possible creation of new epidemic outbreaks. The use of medical devices makes the contamination and the nosocomial virus spread possible, causing infection in medical operators and hospitalized patients. In the neonatal intensive care unit, ultrasound has been an increasingly used tool because it is a non-invasive, repeatable method and it is side effect-free as the newborn is not exposed to radiation. It makes a fast diagnosis and then therapy possible such as in the lung diseases and other life-threatening conditions. The use of portable devices such as the wireless probe has many advantages in routine clinical practice, and during the COVID-19 pandemic, it has proved to be fundamental for the patient and the physician's safety because it reduced the risk of contamination. We report the use of the wireless ultrasound probe in 2 isolated neonates born to SARS-CoV-2-positive mothers.
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Affiliation(s)
- Giorgia Prontera
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Alessandro Perri
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Vito D'Andrea
- Division of Neonatology, Department of Woman and Child Health and Public Health, University Hospital Fondazione Policlinico Gemelli IRCCS, Rome, Italy
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46
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Hattiholi V, Chaitra S. Diagnostic accuracy of bedside lung ultrasound in emergency protocol for the diagnosis of acute respiratory failure. J Med Ultrasound 2022; 30:94-100. [PMID: 35832369 PMCID: PMC9272727 DOI: 10.4103/jmu.jmu_25_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
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Harohalli AV, Anitha Raju NM, Narayanaswamy V. The neonatal lung ultrasound – What should i know as a neonatologist? J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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48
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Wang J, Wei H, Chen H, Wan K, Mao R, Xiao P, Chang X. Application of ultrasonography in neonatal lung disease: An updated review. Front Pediatr 2022; 10:1020437. [PMID: 36389379 PMCID: PMC9640768 DOI: 10.3389/fped.2022.1020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Lung disease is often life-threatening for both preterm and term newborns. Therefore, an accurate and rapid diagnosis of lung diseases in newborns is crucial, as management strategies differ with different etiologies. To reduce the risk of radiation exposure derived from the conventionally used chest x-ray as well as computed tomography scans, lung ultrasonography (LUS) has been introduced in clinical practice to identify and differentiate neonatal lung diseases because of its radiation-free characteristic, convenience, high accuracy, and low cost. In recent years, it has been proved that LUS exhibits high sensitivity and specificity for identifying various neonatal lung diseases. Here, we offer an updated review of the applications of LUS in neonatal lung diseases based on the reports published in recent years (2017 to present).
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Affiliation(s)
- Jin Wang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hongjuan Wei
- Department of Neonatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hui Chen
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Ke Wan
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ruifeng Mao
- School of Life Sciences, Huaiyin Normal University, Huai'an, China
| | - Peng Xiao
- Department of Dermatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xin Chang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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49
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Liu X, Si S, Guo Y, Wu H. Limitations of Bedside Lung Ultrasound in Neonatal Lung Diseases. Front Pediatr 2022; 10:855958. [PMID: 35558371 PMCID: PMC9086677 DOI: 10.3389/fped.2022.855958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Lung ultrasound is a technique that has rapidly developed in recent years. It is a low-cost, radiation-free, and easy-to-operate tool that can be repeatedly performed at the bedside. Compared to chest X-ray, lung ultrasound has high sensitivity and specificity in the diagnosis of neonatal respiratory distress syndrome, transient tachypnoea of newborns and pneumothorax. Lung ultrasound has been widely used in neonatal intensive care units. However, due to the physical barriers of air, where ultrasonic waves cannot pass and therefore reflection artifacts occur, it has limitations in some other lung diseases and cannot fully substitute for chest X-rays or CT/MRI scanning. This review describes these limitations in detail and highlights that if clinical symptoms are not effectively alleviated after medical treatment or the clinical presentation is not compatible with the ultrasound appearances, then chest X-rays or CT/MRI scanning should be performed to avoid misdiagnosis and mistreatment.
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Affiliation(s)
- Xiaolei Liu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Shuyu Si
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Yiyi Guo
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
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50
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Schaal MC, Moritz JD, Mentzel HJ, Beer M. Sonography in Childhood and Adolescence for General Radiologists - More Possibilities Than Expected... ROFO-FORTSCHR RONTG 2021; 194:521-531. [PMID: 34963188 DOI: 10.1055/a-1681-2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sonography is the most common imaging modality in childhood and adolescence. The rapid availability, absence of X-rays, bedside applicability, e. g., in intensive care units, the lack of need for sedation, and last but not least the very good ultrasound conditions in the vast majority of cases are the main advantages of sonography. Due to the spectrum of patients, from premature infants to adolescents, a great variety of questions arise for the examiner. This requires knowledge of the various disease patterns in the different age groups. Proper handling of the young patients as well as their parents is essential in order to make the examination conditions as optimal as possible. Due to the smaller body size compared to adults, sonographic examinations of the abdomen and thorax in children and adolescents are usually possible with very good image quality. In the majority of cases, a definitive diagnosis is made by sonography without additional cross-sectional imaging, which is more common in adults. Due to the acoustic windows provided by the still open fontanelles, excellent image quality of the central nervous system is usually possible in the first year of life. In most cases, complex MRI examinations are not necessary. Due to the partly still missing ossification of the bony structures, further acoustic windows are available, which allow an examination of, e. g., the spinal canal. Ultrasound also plays a major role in the examination of soft tissues and the musculoskeletal system in childhood and adolescence, not only in hip ultrasound. The aim of this article is to show this very broad spectrum for colleagues working predominantly in adult radiology, to highlight some representative examples and to present the respective clinical features in childhood and adolescence. KEY POINTS:: · Ultrasound is the most important initial imaging modality in children and adolescents.. · Often, no further cross-sectional imaging is necessary.. · The most important area of application is the abdomen and pelvis.. · Furthermore, there are additional special applications such as CNS in neonates and infants, thorax, musculoskeletal system.. CITATION FORMAT: · Schaal MC, Moritz JD, Mentzel H et al. Sonography in Childhood and Adolescence for General Radiologists - More Possibilities Than Expected.... Fortschr Röntgenstr 2021; DOI: 10.1055/a-1681-2136.
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Affiliation(s)
- Matthias Cornelius Schaal
- Abteilung für Diagnostische und Interventionelle Radiologie, University Ulm Medical Centre, Ulm, Germany
| | - Jörg Detlev Moritz
- Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany.,Stellv. Leiter Sektion Pädiatrie, DEGUM Deutsche Gesellschaft für Ultraschall in der Medizin, Berlin, Germany.,Vorstand AG Pädiatrische Radiologie, DRG - Deutsche Röntgengesellschaft, Berlin, Germany
| | - Hans-Joachim Mentzel
- Pädiatrische Radiologie, Institut für Diagnostische und Interventionelle Radiologie, Jena, Germany.,Präsident, Gesellschaft für Pädiatrische Radiologie, Berlin, Germany
| | - Meinrad Beer
- Abteilung für Diagnostische und Interventionelle Radiologie, University Ulm Medical Centre, Ulm, Germany
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