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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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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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53
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Vardar G, Karadag N, Karatekin G. The Role of Lung Ultrasound as an Early Diagnostic Tool for Need of Surfactant Therapy in Preterm Infants with Respiratory Distress Syndrome. Am J Perinatol 2021; 38:1547-1556. [PMID: 32674204 DOI: 10.1055/s-0040-1714207] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to determine the accuracy of neonatal lung ultrasound (LUS) in predicting the need for surfactant therapy compared with chest X-ray (CXR) in preterm infants. STUDY DESIGN A prospective double-blind study was conducted in infants with a gestational age <34 weeks with respiratory distress syndrome (RDS) by evaluation with LUS and CXR on admission. RESULTS Among 45 preterm infants, the median (interquartile range [IQR]) LUS score was 4 (2-8) in the mild RDS group, whereas it was 10 (IQR: 9-12) in the severe RDS group (p < 0.01). The LUS score showed a significant correlation with the need for total surfactant doses (ρ = 0.855; 95% confidence interval [CI]: 0.801-0.902; p < 0.001). A cut-off LUS score of four predicted the need for surfactant with 96% sensitivity and 100% specificity (area under the curve [AUC]: 1.00; 95% CI: 0.97-1.00; p < 0.01). LUS scores predicted continuous positive airway pressure (CPAP) failure accurately (AUC: 0.804; 95% CI: 0.673-0.935; p = 0.001). A significant correlation was observed between LUS scores and positive end-expiratory pressure levels (ρ = 0.782; p < 0.001). During the study period, the CXR number per infant with RDS decreased significantly when compared with preceding months (p < 0.001). The LUS score in the first day of life did not predict the development of bronchopulmonary dysplasia (AUC: 0.274; 95% CI: 0.053-0.495; p = 0.065). CONCLUSION The LUS score in preterm infants accurately predicts the severity of RDS, the need for surfactant and CPAP failure. The routine use of LUS can decrease the frequency of CXRs in the neonatal intensive care units. KEY POINTS · LUS is a nonhazardous bedside technique.. · LUS predicts the need for surfactant in preterm infants.. · LUS predicts the severity of RDS better than CXR..
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Affiliation(s)
- Gonca Vardar
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Nilgun Karadag
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Guner Karatekin
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
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Ruoss JL, Bazacliu C, Cacho N, De Luca D. Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care? CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121098. [PMID: 34943297 PMCID: PMC8700415 DOI: 10.3390/children8121098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.
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Affiliation(s)
- J. Lauren Ruoss
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
- Correspondence:
| | - Catalina Bazacliu
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Nicole Cacho
- Division of Neonatology, University of Florida, Gainesville, FL 32610, USA; (C.B.); (N.C.)
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, Paris Saclay University Hospitals, APHP, 94270 Paris, France;
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55
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Camilo GB, Toledo GC, Olímpio H, Dias EN, Oliveira BLD, Ferreira JP, Mendes PDFB, Bastos MG. Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students. J Pediatr (Rio J) 2021; 97:651-657. [PMID: 33713629 PMCID: PMC9432132 DOI: 10.1016/j.jped.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The authors aim to evaluate the "point-of-care" transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. METHODS The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. RESULTS The cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. CONCLUSION Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.
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Affiliation(s)
- Gustavo Bittencourt Camilo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil.
| | - Gabriela Cumani Toledo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil; Hospital e Maternidade Teresinha de Jesus (HMTJ), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Hebert Olímpio
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil
| | - Eleusa Nogueira Dias
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Bianca Lopes de Oliveira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Júlia Perches Ferreira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | | | - Marcus Gomes Bastos
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade Federal de Juiz de Fora (UFJF), Departamento de Nefrologia, Juiz de Fora, MG, Brazil
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56
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Watkins LA, Dial SP, Koenig SJ, Kurepa DN, Mayo PH. The Utility of Point-of-Care Ultrasound in the Pediatric Intensive Care Unit. J Intensive Care Med 2021; 37:1029-1036. [PMID: 34632837 DOI: 10.1177/08850666211047824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: Point of care ultrasound (POCUS) in adult critical care environments has become the standard of care in many hospitals. A robust literature shows its benefits for both diagnosis and delivery of care. The utility of POCUS in the pediatric intensive care unit (PICU), however, is understudied. This study describes in a series of PICU patients the clinical indications, protocols, findings and impact of pediatric POCUS on clinical management. Design: Retrospective analysis of 200 consecutive POCUS scans performed by a PICU physician. Patients: Pediatric critical care patients who required POCUS scans over a 15-month period. Setting: The pediatric and cardiac ICUs at a tertiary pediatric care center. Interventions: Performance of a POCUS scan by a pediatric critical care attending with advanced training in ultrasonography. Measurement and Main Results: A total of 200 POCUS scans comprised of one or more protocols (lung and pleura, cardiac, abdominal, or vascular diagnostic protocols) were performed on 155 patients over a 15-month period. The protocols used for each scan reflected the clinical question to be answered. These 200 scans included 133 thoracic protocols, 110 cardiac protocols, 77 abdominal protocols, and 4 vascular protocols. In this series, 42% of scans identified pathology that required a change in therapy, 26% confirmed pathology consistent with the ongoing plans for new therapy, and 32% identified pathology that did not result in initiation of a new therapy. Conclusions: POCUS performed by a trained pediatric intensivist provided useful clinical information to guide patient management.
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Affiliation(s)
- Laura A Watkins
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 6923Present Affiliation: University of Rochester, Rochester, NY, USA
| | - Sharon P Dial
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Seth J Koenig
- 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dalibor N Kurepa
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Paul H Mayo
- 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- 5799Northwell LIJ/NSUH Hospital, New Hyde Park, NY, USA
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57
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Sansone F, Attanasi M, Di Filippo P, Sferrazza Papa GF, Di Pillo S, Chiarelli F. Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases. Diagnostics (Basel) 2021; 11:1783. [PMID: 34679481 PMCID: PMC8534634 DOI: 10.3390/diagnostics11101783] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/02/2023] Open
Abstract
Respiratory infection diseases are among the major causes of morbidity and mortality in children. Diagnosis is focused on clinical presentation, yet signs and symptoms are not specific and there is a need for new non-radiating diagnostic tools. Among these, lung ultrasound (LUS) has recently been included in point-of-care protocols showing interesting results. In comparison to other imaging techniques, such as chest X-ray and computed tomography, ultrasonography does not use ionizing radiations. Therefore, it is particularly suitable for clinical follow-up of paediatric patients. LUS requires only 5-10 min and allows physicians to make quick decisions about the patient's management. Nowadays, LUS has become an early diagnostic tool to detect pneumonia during the COVID-19 pandemic. In this narrative review, we show the most recent scientific literature about advantages and limits of LUS performance in children. Furthermore, we discuss the major paediatric indications separately, with a paragraph fully dedicated to COVID-19. Finally, we mention potential future perspectives about LUS application in paediatric respiratory diseases.
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Affiliation(s)
- Francesco Sansone
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Marina Attanasi
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Paola Di Filippo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Giuseppe Francesco Sferrazza Papa
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20146 Milan, Italy;
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, 20144 Milan, Italy
| | - Sabrina Di Pillo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Francesco Chiarelli
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
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58
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Boysen SR. Lung Ultrasonography for Pneumothorax in Dogs and Cats. Vet Clin North Am Small Anim Pract 2021; 51:1153-1167. [PMID: 34511293 DOI: 10.1016/j.cvsm.2021.07.003] [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: 10/20/2022]
Abstract
A sonographic diagnosis of pneumothorax (PTX) traditionally relies on excluding the presence of lung sliding, lung pulse, and/or B lines/lung consolidations, and identifying the lung point. However, these criteria can be difficult to identify, particularly in critically ill patients with respiratory disorders, and the lung point is infrequently used. Newer sonographic findings, such as mirrored ribs, reverse lung sliding, and abnormal curtain signs, have been identified to try to increase the accuracy of diagnosing PTX. This article describes and discusses the lung ultrasonography criteria used to diagnose PTX in both human and small animal patients.
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Affiliation(s)
- Søren R Boysen
- Veterinary Emergency and Critical Care, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, 11877 85 Street NW, Calgary, AB T3R 1J3, USA.
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59
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Loi B, Vigo G, Baraldi E, Raimondi F, Carnielli VP, Mosca F, De Luca D. Lung Ultrasound to Monitor Extremely Preterm Infants and Predict Bronchopulmonary Dysplasia. A Multicenter Longitudinal Cohort Study. Am J Respir Crit Care Med 2021; 203:1398-1409. [PMID: 33352083 DOI: 10.1164/rccm.202008-3131oc] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rationale: Lung ultrasound is useful in critically ill patients with acute respiratory failure. Given its characteristics, it could also be useful in extremely preterm infants with evolving chronic respiratory failure, as we lack accurate imaging tools to monitor them. Objectives: To verify if lung ultrasound can monitor lung aeration and function and has good reliability to predict bronchopulmonary dysplasia in extremely preterm neonates. Methods: A multicenter, international, prospective, longitudinal, cohort, diagnostic accuracy study consecutively enrolling inborn neonates with gestational age 30+6 weeks or younger. Lung ultrasound was performed on the 1, 7, 14, and 28 days of life, and lung ultrasound scores were calculated and correlated with simultaneous blood gases and work of breathing score. Gestational age-adjusted lung ultrasound scores were created, verified in multivariate models, and subjected to receiver operator characteristics (ROC) analyses to predict bronchopulmonary dysplasia at 36 weeks postmenstrual age. Measurements and Main Results: Mean lung ultrasound scores are different between infants developing (n = 72) or not developing (n = 75) bronchopulmonary dysplasia (P < 0.001 at any time point). Lung ultrasound scores significantly correlate with oxygenation metrics and work of breathing at any time point (P always < 0.0001). Gestational age-adjusted lung ultrasound scores significantly predict bronchopulmonary dysplasia at 7 (area under ROC curve, 0.826-0.833; P < 0.0001) and 14 (area under ROC curve, 0.834-0.858; P < 0.0001) days of life. Bronchopulmonary dysplasia severity and gestational age-adjusted lung ultrasound scores are significantly correlated at 7 and 14 days (P always < 0.0001). Conclusions: Lung ultrasound scores allow monitoring of lung aeration and function in extremely preterm infants. Gestational age-adjusted scores significantly predict the occurrence of bronchopulmonary dysplasia, starting from the seventh day of life.
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Affiliation(s)
- Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, A.Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Giulia Vigo
- Division of Pediatrics and Neonatal Critical Care, A.Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France
| | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal ICU, Padova University Hospital, Padova, Italy
| | - Francesco Raimondi
- Department of Translational Medical Science, Neonatal ICU, Federico II University, Naples, Italy
| | - Virgilio P Carnielli
- Division of Neonatology, G. Salesi Women and Children Hospital, Polytechnical University of Marche, Ancona, Italy
| | - Fabio Mosca
- Neonatal ICU, "Ca' Granda Ospedale Maggiore Policlinico," IRCCS Foundation, University of Milan, Milan, Italy; and
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A.Béclère Medical Center, Paris Saclay University Hospitals, APHP, Paris, France.,Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
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Raimondi F, Migliaro F, Corsini I, Meneghin F, Pierri L, Salomè S, Perri A, Aversa S, Nobile S, Lama S, Varano S, Savoia M, Gatto S, Leonardi V, Capasso L, Carnielli VP, Mosca F, Dani C, Vento G, Dolce P, Lista G. Neonatal Lung Ultrasound and Surfactant Administration: A Pragmatic, Multicenter Study. Chest 2021; 160:2178-2186. [PMID: 34293317 DOI: 10.1016/j.chest.2021.06.076] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous research shows that a lung ultrasound score (LUS) can anticipate CPAP failure in neonatal respiratory distress syndrome. RESEARCH QUESTION Can LUS also predict the need for surfactant replacement? STUDY DESIGN AND METHODS Multicenter, pragmatic study of preterm neonates who underwent lung ultrasound at birth and those given surfactant by masked physicians, who also were scanned within 24 h from administration. Clinical data and respiratory support variables were recorded. Accuracy of LUS, oxygen saturation to Fio2 ratio, Fio2, and Silverman score for surfactant administration were evaluated using receiver operating characteristic curves. The simultaneous prognostic values of LUS and oxygen saturation to Fio2 ratio for surfactant administration, adjusting for gestational age (GA), were analyzed through a logistic regression model. RESULTS Two hundred forty infants were enrolled. One hundred eight received at least one dose of surfactant. LUS predicted the first surfactant administration with an area under the receiver operating characteristic curve (AUC) of 0.86 (95% CI, 0.81-0.91), cut off of 9, sensitivity of 0.79 (95% CI, 0.70-0.86), specificity of 0.83 (95% CI, 0.76-0.89), positive predictive value of 0.79 (95% CI, 0.71-0.87), negative predictive value of 0.82 (95% CI, 0.75-0.89), positive likelihood ratio of 4.65 (95% CI, 3.14-6.89), and negative likelihood ratio of 0.26 (95% CI, 0.18-0.37). No significant difference was shown among different GA groups: 25 to 27 weeks' GA (AUC, 0.91; 95% CI, 0.84-0.99), 28 to 30 weeks' GA (AUC, 0.81; 95% CI, 0.72-0.91), and 31 to 33 weeks' GA (AUC, 0.88; 95% CI, 0.79-0.95), respectively. LUS declined significantly within 24 h in infants receiving one surfactant dose. When comparing Fio2, oxygen saturation to Fio2 ratio, LUS, and Silverman scores as criteria for surfactant administration, only the latter showed a significantly poorer performance. The combination of oxygen saturation to Fio2 ratio and LUS showed the highest predictive power, with an AUC of 0.93 (95% CI, 0.89-0.97), regardless of the GA interval. INTERPRETATION LUS is a reliable criterion to administer the first surfactant dose regardless of GA. Its association with oxygen saturation to Fio2 ratio significantly improves the prediction power for surfactant need.
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Affiliation(s)
- Francesco Raimondi
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy.
| | - Fiorella Migliaro
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Fabio Meneghin
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Luca Pierri
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Serena Salomè
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Alessandro Perri
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Nobile
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Lama
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Varano
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Sara Gatto
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Valentina Leonardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Virgilio Paolo Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Vento
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasquale Dolce
- Department of Public Health, Università"Federico II" di Napoli, Naples, Italy
| | - Gianluca Lista
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
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Shaahinfar A, Ghazi-Askar ZM. Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:529-554. [PMID: 34215401 DOI: 10.1016/j.emc.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.
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Affiliation(s)
- Ashkon Shaahinfar
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Trailer 3, 747 52nd Street, Oakland, CA 94609, USA; Department of Emergency Medicine, UCSF School of Medicine, 550 16th Street, MH5552, San Francisco, CA, USA.
| | - Zahra M Ghazi-Askar
- Department of Emergency Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room M121, Alway Building MC 5768, Stanford, CA 94305, USA
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62
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Liu J, Lovrenski J, Ye Hlaing A, Kurepa D. Neonatal lung diseases: lung ultrasound or chest x-ray. J Matern Fetal Neonatal Med 2021; 34:1177-1182. [PMID: 31220971 DOI: 10.1080/14767058.2019.1623198] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chest X-ray (CXR) examination is a well-recognized imaging modality in the diagnosis of neonatal lung diseases. On the other hand, lung ultrasound (LUS) has been an emerging and increasingly studied modality. However, the role of LUS as well as its potential to replace CXRs in the detection of neonatal lung diseases has been debated. We combine the present research progress and our own clinical experience to elaborate on various aspects of the potential routine use of lung ultrasound in neonatal intensive care units. We conclude that both LUS and CXR have a number of advantages and disadvantages. They should serve as complementary diagnostic methods in providing accurate, timely, and reliable information.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Arkar Ye Hlaing
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New York, NY, USA
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New York, NY, USA
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63
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Raimondi F, Migliaro F, Corsini I, Meneghin F, Dolce P, Pierri L, Perri A, Aversa S, Nobile S, Lama S, Varano S, Savoia M, Gatto S, Leonardi V, Capasso L, Carnielli VP, Mosca F, Dani C, Vento G, Lista G. Lung Ultrasound Score Progress in Neonatal Respiratory Distress Syndrome. Pediatrics 2021; 147:peds.2020-030528. [PMID: 33688032 DOI: 10.1542/peds.2020-030528] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The utility of a lung ultrasound score (LUS) has been described in the early phases of neonatal respiratory distress syndrome (RDS). We investigated lung ultrasound as a tool to monitor respiratory status in preterm neonates throughout the course of RDS. METHODS Preterm neonates, stratified in 3 gestational age cohorts (25-27, 28-30, and 31-33 weeks), underwent lung ultrasound at weekly intervals from birth. Clinical data, respiratory support variables, and major complications (sepsis, patent ductus arteriosus, pneumothorax, and persistent pulmonary hypertension of the neonate) were also recorded. RESULTS We enrolled 240 infants in total. The 3 gestational age intervals had significantly different LUS patterns. There was a significant correlation between LUS and the ratio of oxygen saturation to inspired oxygen throughout the admission, increasing with gestational age (b = -0.002 [P < .001] at 25-27 weeks; b = -0.006 [P < .001] at 28-30 weeks; b = -0.012 [P < .001] at 31-33 weeks). Infants with complications had a higher LUS already at birth (12 interquartile range 13-8 vs 8 interquartile range 12-4 control group; P = .001). In infants 25 to 30 weeks' gestation, the LUS at 7 days of life predicted bronchopulmonary dysplasia with an area under the curve of 0.82 (95% confidence interval 0.71 to 93). CONCLUSIONS In preterm neonates affected by RDS, the LUS trajectory is gestational age dependent, significantly correlates with the oxygenation status, and predicts bronchopulmonary dysplasia. In this population, LUS is a useful, bedside, noninvasive tool to monitor the respiratory status.
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Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | | | - Pasquale Dolce
- Department of Public Health, Università Federico II di Napoli, Naples, Italy
| | - Luca Pierri
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Alessandro Perri
- Unità Operativa Complessa di Neonatologia, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Nobile
- Unità Operativa Complessa di Neonatologia, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Lama
- Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Silvia Varano
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy; and
| | | | - Sara Gatto
- NICU, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Valentina Leonardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences and
| | - Virgilio Paolo Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy; and
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Vento
- Unità Operativa Complessa di Neonatologia, Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
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Fei Q, Lin Y, Yuan TM. Lung Ultrasound, a Better Choice for Neonatal Pneumothorax: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:359-369. [PMID: 33341304 DOI: 10.1016/j.ultrasmedbio.2020.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/24/2020] [Accepted: 11/16/2020] [Indexed: 06/12/2023]
Abstract
Neonatal pneumothorax is a life-threatening condition. Chest X-ray is the main diagnostic method but has some defects. Lung ultrasound has emerged as a diagnostic method in recent years. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against chest X-ray in neonates with pneumothorax. We searched the Chinese journal full-text database, Wanfang database, China biomedical document service system, Weipu Chinese science and technology periodical full-text database, EMBASE, PubMed, The Cochrane Library and Web of Science (up to January 2020) for prospective studies on the diagnostic accuracy of lung ultrasound in neonates with pneumothorax. Statistical analysis was undertaken using Meta-DiSc software, version 1.4 (Romany Cajal Hospital, Madrid, Spain). The search returned 528 studies, of which 8 full texts were assessed for eligibility against the inclusion/exclusion criteria. The overall specificity and sensitivity of lung ultrasound in the diagnosis of neonatal pneumothorax was 98% (95% confidence interval [CI]: 0.94-0.99) and 99% (95% CI: 0.98-1.00), respectively. The diagnostic odds ratio was 920.01 (95% CI: 265.81-3184.33), and the area under the curve was 0.996 7 (Q* = 0.978 5). However, the chest X-ray was always taken as the reference standard with a sensitivity of 82% (95% CI: 0.72-0.90), a specificity of 96% (95% CI: 0.90-0.99) and a diagnostic odds ratio of 44.54 (95% CI: 4.30-460.98). Study analysis studies indicated that the sensitivity of lung ultrasound in diagnosing pneumothorax excepted chest X-ray as the single diagnosis criteria was 98% (95% CI: 0.93-1.00), the specificity was 100% (95% CI: 0.96-1.00) and the diagnostic odds ratio was 965.39 (95% CI: 161.195781.93), showing a higher accuracy than chest X-ray. In conclusion, lung ultrasound had better sensitivity and specificity than chest X-ray in the diagnosis of pneumothorax. Some ultrasonic signs (absence of lung sliding or B-lines) had a high sensitivity in the diagnosis, which could be used to diagnose pneumothorax. Lung point could help judge the severity of pneumothorax. Its presence indicates that pneumothorax is mild to moderate; otherwise, pneumothorax is severe.
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Affiliation(s)
- Qiang Fei
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
| | - Yu Lin
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Tian-Ming Yuan
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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65
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Sandig J, Bührer C, Czernik C. [Lung Ultrasound in Neonatology to diagnose a Pneumothorax (part one): Evidence - Time for a New Standard Protocol]. Z Geburtshilfe Neonatol 2021; 225:15-18. [PMID: 33412598 DOI: 10.1055/a-1312-7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lung ultrasound is a well-studied diagnostic procedure in emergency medicine. Over the last several years, international research groups have investigated the role of lung ultrasound to evaluate neonatal respiratory diseases. Specific diagnostic algorithms and key features of a neonatal pneumothorax have been released. Compared to X-ray examination, lung ultrasound has many advantages, such as faster diagnostic time, lack of exposure to ionizing radiation, and excellent sensitivity and specificity. Thus, lung ultrasound contributes to the improvement of medical healthcare in the neonatal intensive care unit. We consider the use of lung ultrasound as a new standard procedure to diagnose a pneumothorax in neonatology.
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Affiliation(s)
- Jan Sandig
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin
| | - Christoph Bührer
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin
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66
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Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 2021; 90:524-531. [PMID: 30127522 PMCID: PMC7094915 DOI: 10.1038/s41390-018-0114-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/28/2018] [Accepted: 06/20/2018] [Indexed: 01/29/2023]
Abstract
Lung ultrasound (LUS) is the latest amongst imaging techniques: it is a radiation-free, inexpensive, point-of-care tool that the clinician can use at the bedside. This review summarises the rapidly growing scientific evidence on LUS in neonatology, dividing it into descriptive and functional applications. We report the description of the main ultrasound features of neonatal respiratory disorders and functional applications of LUS aiming to help a clinical decision (such as surfactant administration, chest drainage etc). Amongst the functional applications, we propose SAFE (Sonographic Algorithm for liFe threatening Emergencies) as a standardised protocol for emergency functional LUS in critical neonates. SAFE has been funded by a specific grant issued by the European Society for Paediatric Research. Future potential development of LUS in neonatology might be linked to its quantitative evaluation: we also discuss available data and research directions using computer-aided diagnostic techniques. Finally, tools and opportunities to teach LUS and expand the research network are briefly presented.
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67
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Louis D, Belen K, Farooqui M, Idiong N, Amer R, Hussain A, ElSayed Y. Prone versus Supine Position for Lung Ultrasound in Neonates with Respiratory Distress. Am J Perinatol 2021; 38:176-181. [PMID: 31480084 DOI: 10.1055/s-0039-1695776] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To study the feasibility of lung ultrasound (LUS) in prone position and to compare it with supine position in neonates with respiratory distress. STUDY DESIGN Neonates ≥ 29 weeks of gestational age with respiratory distress requiring respiratory support within first 12 hours of life were enrolled prospectively. First LUS (fLUS) was done in the position infant was nursed (supine or prone), infant's position changed, a second LUS (sLUS) was performed immediately and a third LUS (tLUS) was done 1 to 2 hours later. Primary outcome was the comparison of LUS scores (LUSsc) between fLUS and sLUS. RESULTS Sixty-four neonates were enrolled. Common respiratory diagnoses were transient tachypnea of newborn (TTN; 53%) and respiratory distress syndrome (RDS; 41%). LUSsc was different between fLUS and sLUS (fLUSsc 6 [interquatile range: 4, 7] vs. sLUSsc 7 [4, 10], p < 0.001), while there was no difference between the fLUS and tLUS (fLUSsc 6 [4, 7] vs. tLUSsc 5 [3, 7], p = 0.43). Subgroup analysis confirmed similar findings in neonates with TTN, while in babies with RDS, all the three LUSsc were similar. CONCLUSION LUS is feasible in prone position in neonates. LUS scores were higher immediately after a change in position but were similar to baseline 1 hour after the change in position.
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Affiliation(s)
- Deepak Louis
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Karen Belen
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mansoor Farooqui
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nnanake Idiong
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Reem Amer
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Abrar Hussain
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yasser ElSayed
- Division of Neonatology, Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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68
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Sandig J, Bührer C, Czernik C. [Lung Ultrasound in Neonatology to diagnose a Pneumothorax (part two): A Guideline]. Z Geburtshilfe Neonatol 2020; 225:105-110. [PMID: 33352591 DOI: 10.1055/a-1312-7809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Lung ultrasound is a fast and reliable diagnostic tool in the detection of a neonatal pneumothorax. This tutorial provides basic information for understanding and detecting the generated artefacts, such as A-lines, B-lines, and the lung point. Essential knowledge of these artefacts allows for rule-in and rule-out criteria of a pneumothorax diagnosis. Lung ultrasound could help to reduce the use of radiation in neonatology in the future.
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Affiliation(s)
- Jan Sandig
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin
| | - Christoph Bührer
- Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin
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69
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Alonso-Ojembarrena A, Lechuga-Sancho AM, Morales-Arandojo P, Acuñas-Soto S, López-de-Francisco R, Lubián-López SP. Lung ultrasound score and diuretics in preterm infants born before 32 weeks: A pilot study. Pediatr Pulmonol 2020; 55:3312-3318. [PMID: 32986302 DOI: 10.1002/ppul.25098] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/02/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe if weekly determined lung ultrasound (LU) scores in preterm infants born before 32 weeks (PTB32W) change with diuretic therapy. DESIGN We included infants who received diuretics and compared LU scores according to their evolution on respiratory support (RS) before and after diuretics. RESULTS We included 18 PTB32W divided into two groups. Both groups were similar in terms of median gestational age: 26 weeks (interquartile range [IQR]: 25-28) in the responders' group and 27 weeks (IQR: 24-28) in the other. They differed, however, in the median number of days on invasive mechanical ventilation: 27 (IQR: 11-43) versus 76 (IQR: 35-117), p = .03; in addition to the number of infants with moderate-severe bronchopulmonary dysplasia: 3 (33%) versus 8 (89%), p = .025. The responders' group showed lower LU scores 2 days after diuretics, with a median LU score of 6 (IQR: 3-12) versus 14 (IQR: 12-17) in the nonresponders group, p = .03; 1 week after (3 [IQR: 0-10] versus 12 [12-12], p = .04); and 3 weeks after (5 [IQR: 3-6] versus 12 [10-15], p = .01). RS also decreased at the same time: 7 out of 9 (78%) were extubated in the responders' group, and 1 out of 9 (11%) in the nonresponders group, p = .02, and these differences remained throughout the entire follow-up. CONCLUSIONS There is a group of PTB32W patients whose LU score improves after diuretics. This change appears only in those patients that can be weaned off from RS, and at the same period of time as the administration of diuretics.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - Alfonso María Lechuga-Sancho
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Pediatrics, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Maternal and Child Health and Radiology, School of Medicine, University of Cádiz, Cádiz, Spain
| | - Patricia Morales-Arandojo
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - Silvia Acuñas-Soto
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - Rosa López-de-Francisco
- Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain
| | - Simón Pedro Lubián-López
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain.,Research Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospital, Cádiz, Spain.,Department of Maternal and Child Health and Radiology, School of Medicine, University of Cádiz, Cádiz, Spain
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70
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Liu J, Xia RM, Ren XL, Li JJ. The new application of point-of-care lung ultrasound in guiding or assisting neonatal severe lung disease treatment based on a case series. J Matern Fetal Neonatal Med 2020; 33:3907-3915. [PMID: 30835592 DOI: 10.1080/14767058.2019.1590332] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Lung ultrasound (LUS) has been successfully used for neonatal lung disease diagnosis, as a non-invasive, free of radiation tool, the application of point-of-care LUS (POC-LUS) to diagnose lung disease has become a new trend worldwide. This paper was to introduce the new application of LUS to guide or assist the neonatal lung diseases treatment.Methods: Based on case series of our daily routine clinical work, in combining with the latest literatures, we introducing the new using field of POC-LUS in guiding the treatment of uninflated lung disease by bronchoalveolar lavage (BAL), guiding the treatment of severe pleural effusion and pneumothorax, guide the use of and weaning from mechanical ventilation, and in assessing the efficacy of exogenous pulmonary surfactant (PS) therapy.Results: The results of this study showed that the using rate of invasive ventilation and PS were decreased significantly, the duration of invasive ventilation was shortened significantly, the recovery of pleural effusion and pneumothorax were more quickly and safety, and finally a significantly shortened length of hospitalizations was obtained.Conclusions: LUS monitoring had significant effects in guiding the management of neonatal severe lung diseases, which with the worthy of extensive clinical application.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Rong-Ming Xia
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Jian-Jun Li
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
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71
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Yamaguchi Y, Moharir A, Burrier C, Nomura T, Tobias JD. Point-of-Care Lung Ultrasound to Evaluate Lung Isolation During One-Lung Ventilation in Children: Narrative Review. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:385-389. [PMID: 33235524 PMCID: PMC7680174 DOI: 10.2147/mder.s265074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022] Open
Abstract
This review focuses on the current technique and evidence regarding the use of point-of-care ultrasound (POCUS) to evaluate lung isolation for thorax surgery in infants and children. Previous reports in infants and children are presented. Figures and high-quality video are used to demonstrate the technique for POCUS in pediatric patients and to highlight differences between pediatric and patients. Lung sliding in B-mode and the seashore sign in M-mode suggest that the lung is ventilated. Pediatric anesthesiologists should be familiar with this technique as it is non-invasive and may also be more accurate when compared with auscultation.
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Affiliation(s)
- Yoshikazu Yamaguchi
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Alok Moharir
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Candice Burrier
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Takeshi Nomura
- Department of Intensive Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
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Migliaro F, Salomè S, Corsini I, De Luca D, Capasso L, Gragnaniello D, Raimondi F. Neonatal lung ultrasound: From paradox to diagnosis … and beyond. Early Hum Dev 2020; 150:105184. [PMID: 33010970 PMCID: PMC7481261 DOI: 10.1016/j.earlhumdev.2020.105184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Fiorella Migliaro
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy
| | - Serena Salomè
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Center, South Paris University Hospitals, AP-HP, Paris, France; Medical School, South Paris-Saclay University, Paris, France
| | - Letizia Capasso
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy
| | - Diego Gragnaniello
- Department of Electrical Engineering and Information Technology, Università "Federico II", Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy.
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Del Vecchio A, Salerno S, Barbagallo M, Chirico G, Campoleoni M, Cannatà V, Genovese E, Granata C, Magistrelli A, Tomà P. Italian inter-society expert panel position on radiological exposure in Neonatal Intensive Care Units. Ital J Pediatr 2020; 46:159. [PMID: 33109231 PMCID: PMC7592562 DOI: 10.1186/s13052-020-00905-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/22/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the recent years, clinical progress and better medical assistance for pregnant women, together with the introduction of new complex technologies, has improved the survival of preterm infants. However, this result requires frequent radiological investigations mostly represented by thoracic and abdominal radiographs in incubators. This document was elaborated by an expert panel Italian inter-society working group (Radiologists, Paediatricians, Medical Physicists) with the aim to assist healthcare practitioners in taking choices involving radiation exposures of new-born infants and to provide practical recommendations about justification and optimization in Neonatal Intensive Care Units. The adherence to these practice recommendations could ensure a high quality and patient safety. More complex and less common radiological practice, such as CT scan or fluoroscopy have been excluded. METHODS The consensus was reached starting from current good practice evidence shared by four scientific societies panel: AIFM (Italian Association of Physics in Medicine), SIN (Italian Neonatology Society), SIP (Italian Paediatric Society), SIRM (Italian Medical Radiology Society) in order to guarantee good standard practices for every professional involved in Neonatal Intensive Care Units (NICU). The report is divided into clinical and physical-dosimetric sections: clinical Indications, good practice in radiological exposures, devices, exposure parameters and modalities, patient positioning and immobilization, Reference Diagnostic Levels, operators and patient's radiation protection. Another important topic was the evaluation of the different incubators in order to understand if the consequences of the technological evolution have had an impact on the increase of the dose to the small patients, and how to choose the best device in terms of radiation protection. At the end the working group faced the problem of setting up the correct communication between clinicians and parents following the most recent indications of the international paediatric societies. RESULTS Taking into account the experience and expertise of 10 Italian Centres, the guideline sets out the criteria to ensure a high standard of neonatal care in NICU about procedures, facilities, recommended equipment, quality assurance, radiation protection measures for children and staff members and communication on radiation risk. CONCLUSIONS This document will allow a standardization of the approach to the exposures in NICU, although oriented to a flexible methodology.
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Affiliation(s)
- Antonella Del Vecchio
- Associazione Italiana di Fisica Medica (AIFM), Milan, Italy.
- Servizio di Fisica Sanitaria, IRCCS Ospedale San Raffaele, Via Olgettina, 60, 20132, Milan, Italy.
| | - Sergio Salerno
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
| | | | | | | | | | | | - Claudio Granata
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
| | - Andrea Magistrelli
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
| | - Paolo Tomà
- Società Italiana di Radiologia Medica e Interventistica (SIRM), Milan, Italy
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74
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Kharasch S, Duggan NM, Cohen AR, Shokoohi H. Lung Ultrasound in Children with Respiratory Tract Infections: Viral, Bacterial or COVID-19? A Narrative Review. Open Access Emerg Med 2020; 12:275-285. [PMID: 33116963 PMCID: PMC7569078 DOI: 10.2147/oaem.s238702] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
Respiratory tract infections (RTIs) are common complaints among patients presenting to the pediatric emergency department. In the diagnostic assessment of children with RTIs, many patients ultimately undergo imaging studies for further evaluation. Point-of-care lung ultrasound (LUS) can be used safely and with a high degree of accuracy in differentiating etiologies of RTIs in pediatric patients. Ultrasonographical features such as an irregular pleural line, subpleural consolidations, focal and lobar consolidation and signs of interstitial involvement can be used to distinguish between several pathologies. This work offers a comprehensive overview of pediatric LUS in cases of the most common pediatric RTIs including bacterial and viral pneumonia, bronchiolitis, and COVID-19.
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Affiliation(s)
- Sigmund Kharasch
- Division of Pediatric Emergency Medicine, Division of Emergency Ultrasound, Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Nicole M Duggan
- Harvard Affiliated Emergency Medicine Residency Program, Harvard Medical School, Boston, MA, USA
| | - Ari R Cohen
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Hamid Shokoohi
- Division of Emergency Ultrasound, Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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75
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Rodríguez-Fanjul J, Guitart C, Bobillo-Perez S, Balaguer M, Jordan I. Procalcitonin and lung ultrasound algorithm to diagnose severe pneumonia in critical paediatric patients (PROLUSP study). A randomised clinical trial. Respir Res 2020; 21:255. [PMID: 33032612 PMCID: PMC7543673 DOI: 10.1186/s12931-020-01476-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022] Open
Abstract
Background Lung ultrasound (LUS) in combination with a biomarker has not yet been studied. We propose a clinical trial where the primary aims are: 1. To assess whether an algorithm with LUS and procalcitonin (PCT) may be useful for diagnosing bacterial pneumonia; 2. To analyse the sensitivity and specificity of LUS vs chest X-ray (CXR). Methods/design A 3-year clinical trial. Inclusion criteria: children younger than 18 years old with suspected pneumonia in a Paediatric Intensive Care Unit. Patients will be randomised into two groups: Experimental Group: LUS will be performed as first lung image. Control Group: CXR will be performed as first pulmonary image. Patients will be classified according to the image and the PCT: a) PCT < 1 ng/mL and LUS/CXR are not suggestive of bacterial pneumonia (BN), no antibiotic will be prescribed; b) LUS/CXR are suggestive of BN, regardless of the PCT, antibiotic therapy is recommended; c) LUS/CXR is not suggestive of BN and PCT > 1 ng/mL, antibiotic therapy is recommended. Conclusion This algorithm will help us to diagnose bacterial pneumonia and to prescribe the correct antibiotic treatment. A reduction of antibiotics per patient, of the treatment length, and of the exposure to ionizing radiation and in costs is expected. Trial registration NCT04217980.
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Affiliation(s)
- Javier Rodríguez-Fanjul
- Neonatal Intensive Care Unit, Department of Paediatrics, Hospital Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Carmina Guitart
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Mònica Balaguer
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.
| | - Iolanda Jordan
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, P° Sant Joan de Déu, 2, 08950 Esplugues, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Paediatric Infectious Diseases Research Group. Institut de Recerca Sant Joan de Déu, CIBERESP, Barcelona, Spain
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76
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Corsini I, Parri N, Ficial B, Dani C. Lung ultrasound in pediatric patients: the clinician's point of view. Pediatr Radiol 2020; 50:1635-1636. [PMID: 32870360 DOI: 10.1007/s00247-020-04815-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/01/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Neonatal Intensive Care Unit, Careggi University Hospital of Florence, Largo Brambilla 3, Florence, Italy.
| | - Niccolò Parri
- Department of Pediatric 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
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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Abstract
OBJECTIVES To evaluate if "mirrored ribs"-a mirroring of chest structures-is a sign for pneumothorax in lung ultrasound in neonates. DESIGN Retrospective study. SETTING Medical University Vienna/General Hospital, Vienna, Austria. PATIENTS All neonates admitted with clinical signs of pneumothorax between July 2018 and February 2019. INTERVENTIONS Chest radiograph and lung ultrasound in succession. MEASUREMENTS AND MAIN RESULTS Anterior-posterior chest radiograph and lung ultrasound were compared. "Mirrored ribs" were defined as mirroring of at least one rib and intercostal muscles in B-mode in the absence of B-lines. Twenty-nine cases in 26 patients were considered. Pneumothorax was diagnosed in 55% of cases using reported signs for pneumothorax in lung ultrasound and in 31% using chest radiograph. Lung ultrasound identified all pneumothoraces visible in chest radiograph. "Mirrored ribs" were visible in all patients with signs for pneumothorax and in none without signs for pneumothorax in lung ultrasound, representing a specificity and sensitivity of 100% compared with reported signs for pneumothorax in lung ultrasound. CONCLUSIONS The occurrence of "mirrored ribs" in lung ultrasound in combination with absence of lung sliding, absence of B-lines and lung point might facilitate the rapid recognition of pneumothorax in neonates.
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78
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Su E, Bhombal S, Fraga MV. Where Does Innovation in Critical Care Ultrasound Come From? Perhaps a Look in the Mirror. Pediatr Crit Care Med 2020; 21:919-920. [PMID: 33009311 PMCID: PMC7523474 DOI: 10.1097/pcc.0000000000002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Erik Su
- Division of Critical Care Medicine, Department of Pediatrics, McGovern Medical School, Houston, TX
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA
| | - María V Fraga
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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79
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Li S, Qu YL, Tu MQ, Guo LY, Zhang QL, Lv CY, Guo RJ. Application of lung ultrasonography in critically ill patients with COVID-19. Echocardiography 2020; 37:1838-1843. [PMID: 32931069 DOI: 10.1111/echo.14849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/03/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Lung ultrasonography (LU) is useful to assess lung lesions and variations at bedside. To investigate the results of LU in severe and critical patients with coronavirus disease 2019 (COVID-19), we performed a single-institution study to evaluate the related lung lesions and variations, and prophylactic strategies, in a large referral and treatment center. METHODS We included 91 adult patients with severe and critical COVID-19, namely 62 males and 29 females, with an average age of 59 ± 11 years, who underwent LU. We collected the following patient information: sex, age, days in hospital, and days in ICU. In the ultrasound examinations, we recorded the presence of discrete B lines, confluent B lines, consolidation, pleural thickening, pleural effusion, and pneumothorax (PTX). RESULTS Among the 91 severe and critical patients, 59 cases had scattered B lines, 56 cases had confluent B lines, 58 cases had alveolar-interstitial syndrome (AIS), 48 cases had lung consolidation, six cases had pleural thickening, 39 cases had pleural effusion (average depth of the pleural effusion: 1.0 ± 1.5 cm), and 20 patients developed PTX. In the Cox multivariate analysis, there were significant differences in age, hospitalization days, ICU days, and lung consolidation. CONCLUSION Lung ultrasonography performed at the bedside can detect lung diseases, such as B lines, PTX, pulmonary edema, lung consolidation, pleural effusion, and variations of these findings. Our findings support the use of LU and measurements for estimating factors, and monitoring response to therapy in severe and critical COVID-19 patients.
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Affiliation(s)
- Shuo Li
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ya-Li Qu
- Department of Ultrasound Medicine, Wuhan Jin Yin-Tan Hospital, Wuhan, China
| | - Mu-Qin Tu
- Department of Ultrasound Medicine, Wuhan Jin Yin-Tan Hospital, Wuhan, China
| | - Li-Yan Guo
- Department of Ultrasound Medicine, Wuhan Jin Yin-Tan Hospital, Wuhan, China
| | - Qi-Li Zhang
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chao-Yang Lv
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Rui-Jun Guo
- Department of Ultrasound Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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80
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Hosokawa T, Shibuki S, Tanami Y, Sato Y, Ko Y, Nomura K, Oguma E. Extracardiac Complications in Intensive Care Units after Surgical Repair for Congenital Heart Disease: Imaging Review with a Focus on Ultrasound and Radiography. J Pediatr Intensive Care 2020; 10:85-105. [PMID: 33884209 DOI: 10.1055/s-0040-1715483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/24/2020] [Indexed: 12/24/2022] Open
Abstract
Pediatric patients show various extracardiac complications after cardiovascular surgery, and radiography and ultrasound are routinely performed in the intensive care unit to detect and evaluate these complications. This review presents images of these complications, sonographic approach, and timing of occurrence that are categorized based on their extracardiac locations and include complications pertaining to the central nervous system, mediastinum, thorax and lung parenchyma, diaphragm, liver and biliary system, and kidney along with pleural effusion and iatrogenic complications. This pictorial review will make it easier for medical doctors in intensive care units to identify and manage various extracardiac complications in pediatric patients after cardiovascular surgery.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Saki Shibuki
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshihiro Ko
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Koji Nomura
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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81
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Mazmanyan P, Kerobyan V, Shankar-Aguilera S, Yousef N, De Luca D. Introduction of point-of-care neonatal lung ultrasound in a developing country. Eur J Pediatr 2020; 179:1131-1137. [PMID: 32060800 DOI: 10.1007/s00431-020-03603-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/26/2022]
Abstract
Despite neonatal lung ultrasound (LU) being diffused worldwide, its introduction in limited-resource areas has not been formally investigated. We conceived a project to introduce it in a level 3 NICU of a developing country and verify if, after a short protocolized training, clinicians may efficaciously use LU. Inter-rater agreement between ultrasound trainees and trainers was analyzed within both the local test and the diffusion phases of the project. High inter-rater agreements were found between expert trainers and the two neonatologists who were trained in a skilled European center (Cohen's Kappa, 0.951; 95%CI, 0.882-0.999), as well as between the two and the second round of locally trained colleagues (Cohen's Kappa, 0.896; 95%CI, 0.797-0.996). Moreover, a high agreement was found between the clinical respiratory diagnosis (used as the "gold standard") and the LU diagnosis given by the first two trainees (intraclass correlation, 0.992; 95%CI, 0.987-0.996) and the locally trained physicians (intraclass correlation, 0.97; 95%CI, 0.95-0.98). A final survey demonstrated that the project was perceived as efficacious and that LU was going to be integrated into routine clinical practice.Conclusions: А short LU training provided sufficient proficiency and allowed the LU introduction in clinical practice in the neonatal intensive care unit in a developing country.What is Known:• Lung ultrasound is a promising technique for evaluating neonatal respiratory distress at least in high-income countries. Previous studies revealed high specificity and sensitivity in diagnosing specific neonatal disorders.• An important barrier to the more extensive use of lung ultrasound in neonatal critical care is a lack of efficient and suitable training solutions.What is New:• Descriptive LU performed by neonatologist in a developing country after a short formal training is feasible with good quality.• A short formal LU training program provided good proficiency and allowed a correct descriptive diagnosis in a neonatal unit in a developing country.
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Affiliation(s)
- P Mazmanyan
- Department of Neonatology, Yerevan State Medical University, 2 Koryun St, 0025, Yerevan, Armenia.
| | - V Kerobyan
- Department of Neonatology, Yerevan State Medical University, 2 Koryun St, 0025, Yerevan, Armenia
| | - S Shankar-Aguilera
- Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
| | - N Yousef
- Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
| | - D De Luca
- Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
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82
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Corsini I, Parri N, Ficial B, Dani C. Lung ultrasound in the neonatal intensive care unit: Review of the literature and future perspectives. Pediatr Pulmonol 2020; 55:1550-1562. [PMID: 32339409 DOI: 10.1002/ppul.24792] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/30/2023]
Abstract
Lung ultrasound (LU) has been increasingly used as a point-of-care method in recent years. LU has numerous advantages compared to traditional imaging tools such as chest X-ray (radiography) (CXR): it is faster and portable, does not use ionizing radiation, is performed by the same physician who cares for the patient, and can be repeated to follow the progress of the disease and the response to treatment. There is a large body of evidence that LU has an excellent diagnostic effectiveness compared to CXR, not only in adults and children, but also in neonates. This review article describes how to perform LU, how to interpret findings, and how to use LU to diagnose and differentiate common neonatal pulmonary diseases. Strengths but also limits of the technique are highlighted. Finally, we describe the recent revolutionary role of LU. The development of scoring methods in neonates with respiratory distress syndrome allowed to quantify the severity of the disease and to assist the physician in the clinical management and follow-up.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Niccolò Parri
- Department of Pediatric 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
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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83
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Defining information needs in neonatal resuscitation with work domain analysis. J Clin Monit Comput 2020; 35:689-710. [PMID: 32458169 DOI: 10.1007/s10877-020-00526-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 05/07/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To gain a deeper understanding of the information requirements of clinicians conducting neonatal resuscitation in the first 10 min after birth. BACKGROUND During the resuscitation of a newborn infant in the first minutes after birth, clinicians must monitor crucial physiological adjustments that are relatively unobservable, unpredictable, and highly variable. Clinicians' access to information regarding the physiological status of the infant is also crucial to determining which interventions are most appropriate. To design displays to support clinicians during newborn resuscitation, we must first carefully consider the information requirements. METHODS We conducted a work domain analysis (WDA) for the neonatal transition in the first 10 min after birth. We split the work domain into two 'subdomains'; the physiology of the neonatal transition, and the clinical resources supporting the neonatal transition. A WDA can reveal information requirements that are not yet supported by resources. RESULTS The physiological WDA acted as a conceptual tool to model the exact processes and functions that clinicians must monitor and potentially support during the neonatal transition. Importantly, the clinical resources WDA revealed several capabilities and limitations of the physical objects in the work domain-ultimately revealing which physiological functions currently have no existing sensor to provide clinicians with information regarding their status. CONCLUSION We propose two potential approaches to improving the clinician's information environment: (1) developing new sensors for the information we lack, and (2) employing principles of ecological interface design to present currently available information to the clinician in a more effective way.
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84
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The Use of Ultrasonography in the Emergency Department to Screen Patients After Blunt and Penetrating Trauma: A Clinical Update for the Advanced Practice Provider. Adv Emerg Nurs J 2020; 41:290-305. [PMID: 31687993 DOI: 10.1097/tme.0000000000000267] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Use of bedside ultrasonography to identify life-threatening injuries for patients with blunt and penetrating trauma is the standard of care in the emergency department. The "FAST" examination-focused assessment with sonography for trauma-ultrasound scan of the chest and abdomen allows clinicians to assess critical regions for free fluid without use of invasive procedures as quickly and as often as needed. In addition, ultrasonography has a high degree of sensitivity and specificity and is safe during pregnancy. For patients requiring evaluation of the pleura, the "eFAST" (or extended FAST) may be conducted, which may serve to locate pleural effusions, hemothorax, and pneumothorax. However, ultrasound quality is operator dependent and is recommended with other diagnostic measures to provide a complete clinical picture of trauma patients. Ongoing development of ultrasound competency among established clinicians and nurse practitioner students is vital to maintain diagnostic accuracy and ensure quality care for trauma patients in the emergency department.
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85
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Effect of Different Probes and Expertise on the Interpretation Reliability of Point-of-Care Lung Ultrasound. Chest 2020; 157:924-931. [DOI: 10.1016/j.chest.2019.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/14/2019] [Accepted: 11/09/2019] [Indexed: 01/19/2023] Open
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86
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Lung ultrasound for detecting pneumothorax in injured children: preliminary experience at a community-based Level II pediatric trauma center. Pediatr Radiol 2020; 50:329-337. [PMID: 31473787 DOI: 10.1007/s00247-019-04509-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/17/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ultrasound (US) has been used in the adult trauma population with reported moderate to high sensitivities, but data are scarce in the pediatric trauma population. OBJECTIVE The purpose of this study was to specifically examine the sensitivity and specificity of one lung US methodology (single-point anterior exam) in the pediatric trauma population when compared to chest radiography or CT. MATERIALS AND METHODS We conducted a retrospective review of pediatric trauma patients who received lung US as an extension of the focused assessment with sonography for trauma (FAST) exam. We compared lung US findings with chest radiography and CT scans. RESULTS Two hundred twenty-six pediatric trauma patients underwent lung US exam with confirmatory exams; 11 pneumothoraces (4.8%) were observed. Of those 11, 6 were evaluated as false negatives on the lung US. Analyses resulted in 45.5% sensitivity, 98.6% specificity and 96.0% accuracy. Pneumothoraces undetected by lung US were small and apical and were likely not observed because of their size and location. None of the false negatives required intervention. All true positives were associated with lung contusions. CONCLUSION Pneumothorax is less common in the pediatric than the adult trauma population, and when encountered in children pneumothorax is often occult and might be associated with lung contusions. Existing evidence supports the usefulness of chest US in detecting pneumothorax in adults and suggests that it can be translated to injured children. However, our findings suggest that the sensitivity of lung US as a single-point anterior exam extension of the FAST exam might not be as reliable in the pediatric trauma population as in adults. Other methodologies using lung US might improve sensitivity.
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87
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Lovrenski J. Pediatric lung ultrasound - pros and potentials. Pediatr Radiol 2020; 50:306-313. [PMID: 32065266 DOI: 10.1007/s00247-019-04525-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
Abstract
Lung ultrasound (US) cannot be considered a new diagnostic imaging technique anymore, with some articles dating back 50 years. The question that hovers over it recently is why it is still not widely accepted, like chest radiography. So, have we wasted a lot of time without using lung US, or are we wasting our time using lung US? The main goals of this article are to underline all the advantages, potentials and reasons to use lung US in everyday clinical practice, but also to address the main concerns linked to this imaging tool. From the standpoint of an experienced pediatric radiologist from a tertiary health care children's hospital who has been performing this examination for more than 10 years on a daily basis, this article also addresses the most common applications of lung US, such as detection of pneumonia and neonatal lung diseases.
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Affiliation(s)
- Jovan Lovrenski
- Radiology Department, Faculty of Medicine, University of Novi Sad and Institute for Children and Adolescents Health Care of Vojvodina, Hajduk Veljkova 3, Novi Sad, 21000, Serbia.
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88
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Tomà P. Lung ultrasound in pediatric radiology - cons. Pediatr Radiol 2020; 50:314-320. [PMID: 32065267 DOI: 10.1007/s00247-019-04524-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/25/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023]
Abstract
In the 1990s, intensivists suggested a new type of sonography: lung ultrasound, based on artefacts that receive information even from physical acoustic phenomena not directly convertible into images of the human body. They compared the artefacts from the lung zones with no acoustic window with various computed tomography (CT) patterns. They used and still use US as a tool to evaluate patients bedside, i.e. monitoring of lung recruitment. They included Lung ultrasound in what was termed POCUS (Point-of-Care Ultrasound). Lung ultrasound has been progressively extended to paediatrics in general. The most appealing novelty has been the diagnosis of pneumothorax. Lung ultrasound was developed as a support tool for critical patients. Extrapolation with mass diffusion, in the absence of appropriate training, has led to misunderstandings and dangerous therapeutic diagnostic drifts.
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Affiliation(s)
- Paolo Tomà
- Ospedale pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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89
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Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, Lopez J, Sanchez-de-Toledo J, Brierley J, Colunga JM, Raffaj D, Da Cruz E, Durand P, Kenderessy P, Lang HJ, Nishisaki A, Kneyber MC, Tissieres P, Conlon TW, De Luca D. International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:65. [PMID: 32093763 PMCID: PMC7041196 DOI: 10.1186/s13054-020-2787-9] [Citation(s) in RCA: 302] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.
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Affiliation(s)
- Yogen Singh
- Department of Paediatrics - Neonatology and Paediatric Cardiology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Addenbrooke's Hospital, Box 402, Cambridge, UK.
| | - Cecile Tissot
- Paediatric Cardiology, Centre de Pédiatrie, Clinique des Grangettes, Geneva, Switzerland
| | - María V Fraga
- Department of Paediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Nadya Yousef
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
| | - Rafael Gonzalez Cortes
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jorge Lopez
- Department of Paediatric Intensive Care, Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Joe Brierley
- Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Juan Mayordomo Colunga
- Department of Paediatric Intensive Care, Hospital Universitario Central de Asturias, Oviedo. CIBER-Enfermedades Respiratorias. Instituto de Salud Carlos III, Madrid. Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Dusan Raffaj
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Eduardo Da Cruz
- Department of Paediatric and Cardiac Intensive Care, Children's Hospital Colorado, Aurora, USA
| | - Philippe Durand
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Peter Kenderessy
- Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital Banska Bystrica, Banska Bystrica, Slovakia
| | - Hans-Joerg Lang
- Department of Paediatrics, Medicins Sans Frontieres (Suisse), Geneva, Switzerland
| | - Akira Nishisaki
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Martin C Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pierre Tissieres
- Division of Paediatric Critical Care, APHP - Paris Saclay University Hospitals, "Kremlin Bicetre" Medical Centre, Paris, France
| | - Thomas W Conlon
- Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, USA
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP - Paris Saclay University Hospitals, "A. Béclère" Medical centre, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM Unit U999, South Paris Medical School, Paris Saclay University, Paris, France
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90
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Hegazy LM, Rezk AR, Sakr HM, Ahmed AS. Comparison of Efficacy of LUS and CXR in the Diagnosis of Children Presenting with Respiratory Distress to Emergency Department. Indian J Crit Care Med 2020; 24:459-464. [PMID: 32863640 PMCID: PMC7435092 DOI: 10.5005/jp-journals-10071-23459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Respiratory distress (RD) in children is a life-threatening condition. Delay in diagnosis has a deleterious effect on morbidity and mortality. The bedside lung ultrasound in emergency (BLUE) is a fast method that aims to accelerate the diagnosis with minimal radiological exposure. We targeted to evaluate the efficacy of BLUE protocol to speed and increase the precision of recognizing the cause of RD compared with chest X-ray (CXR) in the emergency department. Materials and methods A cross-sectional study on 63 children with RD attended the emergency of a tertiary, university-affiliated, pediatric medical center between January 2017 and January 2018. Results Most cases were males 52.4%. We designed to estimate the value of BLUE as a diagnostic tool for RD and comparing it with CXR. Pneumonia with or without pleural effusion was the main etiology of RD detected by BLUE in 47.7% of studied children, pulmonary edema in 22.2%, bronchiolitis and asthma in 17.4%, and pneumothorax in 12.7%. Lung ultrasound (LUS) was superior to CXR in the diagnosis of RD cause, and most cases, 47.7% were diagnosed with pneumonia with a sensitivity of 93.5% and specificity 96.9%. Conclusion Bedside lung ultrasound in emergency is an effective tool for identifying the cause of RD which is more sensitive and specific compared with CXR. How to cite this article Hegazy LM, Rezk AR, Sakr HM, Ahmed AS. Comparison of Efficacy of LUS and CXR in the Diagnosis of Children Presenting with Respiratory Distress to Emergency Department. Indian J Crit Care Med 2020;24(6):459–464.
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Affiliation(s)
- Laila M Hegazy
- Department of Pediatrics, Ain Shams University Hospital, Cairo, Egypt
| | - Ahmed R Rezk
- Department of Pediatrics, Ain Shams University Hospital, Cairo, Egypt
| | - Hossam M Sakr
- Department of Radiology, Ain Shams University Hospital, Cairo, Egypt
| | - Asmaa S Ahmed
- Department of Pediatrics, Ain Shams University Hospital, Cairo, Egypt
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91
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Thakur A, Kler N, Garg P. Lung Ultrasound for Detection of Pneumothorax in Neonates. Indian J Pediatr 2019; 86:1148. [PMID: 31325099 DOI: 10.1007/s12098-019-03030-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Anup Thakur
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India.
| | - Neelam Kler
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
| | - Pankaj Garg
- Department of Neonatology, Institute of Child Health, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
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92
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Abstract
Point-of-care, or clinician-performed ultrasound (CPU), is increasingly utilised within neonatology as a valuable adjunct to clinical examination. The ability to perform and interpret rapid, real-time, serial assessment of patient physiology at the bedside has seen the potential uses of CPU expand, with an evolving list of clinical and research applications. Benefits of functional assessment of neonatal haemodynamics in particular have been described across a range of gestational ages and disease states. Devising suitable curricula for trainees and ensuring robust processes for the training and credentialing of clinicians performing CPU is essential. Challenges to universal implementation of CPU in the neonatal intensive care setting exist, and regional differences in training and accreditation are well described. Appropriate integration into clinical decision-making and ensuring competency-based locally appropriate training programs, which build on an expanding evidence base, are key priorities in ensuring newborns receive optimal benefit from the modality.
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93
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Fraga MV, Stoller JZ, Glau CL, De Luca D, Rempell RG, Wenger JL, Yek Kee C, Muhly WT, Boretsky K, Conlon TW. Seeing Is Believing: Ultrasound in Pediatric Procedural Performance. Pediatrics 2019; 144:peds.2019-1401. [PMID: 31615954 DOI: 10.1542/peds.2019-1401] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 11/24/2022] Open
Abstract
Point-of-care ultrasound is currently widely used across the landscape of pediatric care. Ultrasound machines are now smaller, are easier to use, and have much improved image quality. They have become common in emergency departments, ICUs, inpatient wards, and outpatient clinics. Recent growth of supportive evidence makes a strong case for using point-of-care ultrasound for pediatric interventions such as vascular access (in particular, central-line placement), lumbar puncture, fluid drainage (paracentesis, thoracentesis, pericardiocentesis), suprapubic aspiration, and soft tissue incision and drainage. Our review of this evidence reveals that point-of-care ultrasound has become a powerful tool for improving procedural success and patient safety. Pediatric patients and clinicians performing procedures stand to benefit greatly from point-of-care ultrasound, because seeing is believing.
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Affiliation(s)
| | | | - Christie L Glau
- Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France.,Physiopathology and Therapeutic Innovation Unit, Institut National de la Santé et de la Recherche Médicale U999, South Paris-Saclay University, Paris, France
| | | | - Jesse L Wenger
- Division of Pediatric Critical Care Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Chor Yek Kee
- Department of Pediatrics, Sarawak General Hospital, Sarawak, Malaysia; and
| | - Wallis T Muhly
- Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Boretsky
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Harvard University and Boston Children's Hospital, Boston, Massachusetts
| | - Thomas W Conlon
- Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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94
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Grimaldi C, Michel F, Brévaut-Malaty V, Hassid S, Nicaise C, Puech B, Thomachot L, Vialet R, Tosello B, Panuel M. Thoracic ultrasound accuracy for the investigation of initial neonatal respiratory distress. Arch Pediatr 2019; 26:459-465. [DOI: 10.1016/j.arcped.2019.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 07/01/2019] [Accepted: 09/22/2019] [Indexed: 11/25/2022]
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95
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Szymońska I, Wentrys Ł, Jagła M, Olszewska M, Wasilewska W, Smykla B, Kwinta P. Lung ultrasound reduces the number of chest X-rays in newborns with pneumothorax. DEVELOPMENTAL PERIOD MEDICINE 2019; 23. [PMID: 31654995 PMCID: PMC8522409 DOI: 10.34763/devperiodmed.20192303.172177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aim of the study: To determine the impact of lung ultrasonography as an imaging method used to diagnose and monitor newborns with symptomatic pneumothorax and to assess the risk factors for pneumothorax and the outcomes in newborns with symptomatic pneumothorax. PATIENTS AND METHODS Material and methods: A single-centre retrospective study enrolled patients born after 32 weeks of gestation, with a diagnosis of pneumothorax in the first week of life. The 118 patients who were included in the study were divided into two groups. Group A (51 infants) comprised those children who were treated between 2007 and 2010, while group B (n=67) those from the years 2013 to 2016. The children from group A were monitored with repeated chest X-rays. Those from group B received repeated lung ultrasonography supported by chest X-ray in those cases where there was diagnostic uncertainty. Comparison was made between the groups with respect to pneumothorax risk factors, treatment methods and the use of imaging during the period of treatment. The statistical analysis used χ2, Mann-Whitney and Student's t-tests. RESULTS Results: There were no significant demographic or clinical differences between the two groups. Both the use of nCPAP (nasal continuous positive airway pressure) (p<0.001) and diagnosed perinatal asphyxia (p=0.036) were higher in group B. Congenital pneumonia occurred more often in group A (p=0.041). Earlier detection of pneumothorax (p=0.001) and shorter hospital stay (p=0.03) were observed in group B. However, the total number of imaging (lung ultrasound and chest X-ray combined) was higher (p<0.001) in group B. CONCLUSION Conclusion: This study confirmed the usefulness of lung ultrasound in monitoring newborns with pneumothorax, moreover significantly limiting X-ray radiation.
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Affiliation(s)
- Izabela Szymońska
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland,Izabela SzymońskaDepartment of Pediatrics, Jagiellonian University Collegium Medicum, ul. Wielicka 265, 30-663 Kraków, Poland Mobile phone: +48 692-410-440 fax: (+48 12) 658-44-46
| | - Łukasz Wentrys
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Mateusz Jagła
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Marta Olszewska
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Weronika Wasilewska
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Barbara Smykla
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Collegium Medicum, Kraków, Poland
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96
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Conlon TW, Nishisaki A, Singh Y, Bhombal S, De Luca D, Kessler DO, Su ER, Chen AE, Fraga MV. Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice. Pediatrics 2019; 144:peds.2019-1402. [PMID: 31481415 DOI: 10.1542/peds.2019-1402] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.
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Affiliation(s)
- Thomas W Conlon
- Departments of Anesthesiology and Critical Care Medicine and
| | - Akira Nishisaki
- Departments of Anesthesiology and Critical Care Medicine and
| | - Yogen Singh
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Hopital Antoine Béclère, University Hospitals of South Paris, AP-HP, Paris, France.,Physiopathology and Therapeutic Innovation Unit, Inserm U999, Université Paris-Saclay, Paris, France; and
| | - David O Kessler
- Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Erik R Su
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Aaron E Chen
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - María V Fraga
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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97
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Rodriguez-Fanjul J, Perez-Baena L, Perez A. Cardiopulmonary resuscitation in newborn infants with ultrasound in the delivery room. J Matern Fetal Neonatal Med 2019; 34:2399-2402. [PMID: 31455141 DOI: 10.1080/14767058.2019.1661379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Point of care ultrasound has emerged as useful tool in cardiac arrest situations in adult population. Despite of these, there is not a protocol for cardiopulmonary resuscitation in the delivery room for newborns. We describe two case were ultrasound helped to rule out the cardiopulmonary arrest case and we propose and algorithm were ultrasound is integrated in the newborn resuscitation and may help to diagnose the cardiac arrest cause.
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Affiliation(s)
- Javier Rodriguez-Fanjul
- Pediatric Intensive Care Unit, Pediatric Department, Joan XXIII University Hospital in Tarragona, Tarragona, Spain
| | - Luis Perez-Baena
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Alberto Perez
- Neonatal Intensive Care Unit, Hospital Universitario Basurto, Bilbao, Spain
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98
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Woods PL. Utility of lung ultrasound scanning in neonatology. Arch Dis Child 2019; 104:909-915. [PMID: 30413490 DOI: 10.1136/archdischild-2017-314538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 12/31/2022]
Abstract
The utility of point-of-care lung ultrasound in neonatology is rapidly expanding. This review summarises current evidence of a diagnostic, procedural and observational tool valuable in the management of newborns requiring intensive care. Approaching a patient, probe in-hand with focused clinical question is essential, and barriers to implication together with important research questions are explored.
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Affiliation(s)
- Patricia Lee Woods
- Neonatal Directorate, King Edward Memorial Hospital for Women Perth, Perth, Western Australia, Australia.,Centre for Neonatal Research & Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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99
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Heuvelings CC, Bélard S, Familusi MA, Spijker R, Grobusch MP, Zar HJ. Chest ultrasound for the diagnosis of paediatric pulmonary diseases: a systematic review and meta-analysis of diagnostic test accuracy. Br Med Bull 2019; 129:35-51. [PMID: 30561501 DOI: 10.1093/bmb/ldy041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 10/15/2018] [Accepted: 11/21/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Chest ultrasound is an emerging imaging modality, for several paediatric pulmonary diseases. SOURCES OF DATA MEDLINE and EMBASE (1946-47 to 10 March 2017) were searched to collect evidence on the diagnostic accuracy of chest ultrasound, compared to other imaging modalities, for the diagnosis of paediatric pulmonary diseases. AREAS OF AGREEMENT Eighteen pneumonia studies, comprising 2031 children, were included for meta-analysis; the summary estimate sensitivity was 95.0% (95%CI: 90.7-97.3%) and specificity was 96.1% (95%CI: 89.1-98.7%). AREAS OF CONTROVERSY Other pulmonary diseases also yielded high sensitivity and specificity, but a meta-analysis could not be conducted due to a limited number of studies includable, and their heterogeneity. GROWING POINTS Chest ultrasound should be considered as a first-line imaging modality for children with suspected pneumonia. AREAS TIMELY FOR DEVELOPING RESEARCH Further research should focus on the diagnostic accuracy of chest ultrasound for the diagnosis of paediatric pulmonary diseases, other than pneumonia, comparing against a valid gold standard.
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Affiliation(s)
- Charlotte C Heuvelings
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Academic Medical Centers, location AMC, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Pediatrics and Child Health, MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa
| | - Sabine Bélard
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Academic Medical Centers, location AMC, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Pediatrics and Child Health, MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa.,Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany Berlin, Germany.,Anna-Louisa-Karsch-Straβe 2, Berlin, Germany
| | - Mary A Familusi
- Department of Statistical Science, University of Cape Town, Rondebosch, Cape Town, South Africa
| | - Rene Spijker
- Medical Library, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, CG Utrecht, The Netherlands
| | - Martin P Grobusch
- Department of Infectious Diseases, Division of Internal Medicine, Center of Tropical Medicine and Travel Medicine, Amsterdam Academic Medical Centers, location AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - Heather J Zar
- Department of Pediatrics and Child Health, MRC Unit on Child & Adolescent Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, South Africa
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[Guideline on lung ultrasound to diagnose pulmonary diseases in newborn infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:105-113. [PMID: 30782270 PMCID: PMC7389823 DOI: 10.7499/j.issn.1008-8830.2019.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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