Lung Ultrasound in Early Preterm Life: A Window into the Future?

Guidelines for the use of lung ultrasound to optimise the management of neonatal respiratory distress: international expert consensus

BACKGROUND

Respiratory distress is the main reason for the admission of infants to the neonatal intensive care unit (NICU). Rapid identification of the causes of respiratory distress and selection of appropriate and effective treatment strategies are important to optimise favourable short- and long-term patient outcomes. Lung ultrasound (LUS) technology has become increasingly important in this field. According to the scientific literature, LUS has high sensitivity (92-99%) and specificity (95-97%) in diagnosing neonatal respiratory distress syndrome. This diagnostic power helps guide timely interventions, such as surfactant therapy and mechanical ventilation.

METHODS

Our objective was to outline consensus guidelines among an international panel of experts on the use of LUS to support the decision-making process in managing respiratory distress in the NICU. We used a three-round Delphi process. In each Delphi round, 28 panellists rated their level of agreement with each statement using a four-point Likert scale.

RESULTS

In round 1, the panellists reviewed 30 initially proposed statements. In rounds 2 and 3, the statements were redeveloped based on the reviewers' comments, leading to the final approval of 18 statements. Among the 18 consensus statements, grade A was assigned a value of 10, grade B was assigned a value of 7, and grade C was assigned a value of 1.

CONCLUSIONS

A panel of experts agreed on 18 statements regarding managing infants with respiratory distress. Using LUS may help design future interventional studies and improve the benchmarking of respiratory care outcomes.

Cross-sectional chest circumference and shape development in infants

OBJECTIVE

This study investigates the development of the thoracic cross-section at the nipple line level during the early stages of life. Unlike the descriptive awareness regarding chest development course, there exist no quantitative references concerning shape, circumference and possible dependencies to age, gender or body weight. The proposed mathematical relations are expected to help create guidelines for more realistic modelling and potential detection of abnormalities. One potential application is lung electrical impedance tomography (EIT) monitoring where accurate chest models are crucial in both extracting reliable parameters for regional ventilation function and design of EIT belts. Despite their importance, such reference data is not readily available for the younger age range due to insufficient data amid the regulations of neonatal imaging.

RESULTS

Chest circumference shows the highest correlation to body weight following the relation [Formula: see text] where x is the body weight in grams and f(x) is the chest circumference in cm at the nipple line level. No statistically significant difference in chest circumference between genders was detected. However, the shape indicated signs of both age and gender dependencies with on average boys developing a more rectangular shape than girls from the age of 1 years and 9 months.