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Singh Y, Dauengauer-Kirliene S, Yousef N. Setting the Standards: Neonatal Lung Ultrasound in Clinical Practice. Diagnostics (Basel) 2024; 14:1413. [PMID: 39001302 PMCID: PMC11241677 DOI: 10.3390/diagnostics14131413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/16/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
The use of lung ultrasonography in neonates is increasing at a very fast rate. Evidence-based guidelines on the use of lung ultrasound (LU) in neonates and children have been published and well received across the world. However, there remains a lack of standardized curriculum for lung ultrasound training and standards for its application at the bedside. This article focuses on providing a standardized approach to the application of lung ultrasonography in neonates for the common neonatal conditions and how it can be integrated into bedside clinical decision-making.
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Affiliation(s)
- Yogen Singh
- Department of Pediatrics, Division of Neonatology, UC Davis Children's Hospital, UC Davis Health, Sacramento, CA 95816, USA
| | - Svetlana Dauengauer-Kirliene
- Department of Human and Medical Genetics, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Santariškių 2, LT-08661 Vilnius, Lithuania
| | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, 92140 Paris, France
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Griksaitis MJ, Zoica B, Raffaj D, Stephens J, Sarfatti A, Rajagopal V, Hargadon-Lowe A, Green J, Shires P, Skevington-Postles L, Davies P. Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study. Arch Dis Child 2024; 109:543-549. [PMID: 38442949 DOI: 10.1136/archdischild-2024-326904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Point-of-care ultrasound (POCUS) is an established, evidence-supported tool that can be used in neonatal and paediatric medicine, offering clinicians immediate diagnostic insights, assessment of interventions and improved safety profiles and success rate of various procedures. Its effective use requires an established education programme, governance and standardisation to ensure competence in this skill. While adult clinical practice has established POCUS training protocols, this had not been replicated in paediatrics. This article describes the development and launch of the UK's inaugural accredited paediatric-specific POCUS curriculum and training pathway: the 'Children's ACuTe UltraSound' course, addressing this significant gap in paediatric healthcare education and describing the training delivered and available for paediatricians and allied health professionals working with children.
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Affiliation(s)
- Michael J Griksaitis
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Bogdana Zoica
- King's College Hospital NHS Foundation Trust, London, UK
| | - Dusan Raffaj
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Jennie Stephens
- Intensive Care & Acute Medicine, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Avishay Sarfatti
- Paediatric Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Veena Rajagopal
- Paediatric Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Jessica Green
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Peter Shires
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | | | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
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Recker F, Kipfmueller F, Wittek A, Strizek B, Winter L. Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature. Life (Basel) 2024; 14:658. [PMID: 38929641 PMCID: PMC11204601 DOI: 10.3390/life14060658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Point-of-care ultrasound (POCUS) integration into neonatology offers transformative potential for diagnostics and treatment, enhancing immediacy and precision of clinical decision-making in this vulnerable patient population. This systematic review aims to synthesize evidence on POCUS applications, benefits, challenges, and educational strategies in neonatology. Literature search was conducted using SPIDER scheme keywords and MeSH terms related to POCUS and neonatology. Studies focusing on POCUS applications, its impact on clinical outcomes, and educational interventions for skill acquisition were included and analyzed using standardized tools, followed by a narrative synthesis of the findings. The search yielded 68 relevant publications, encompassing original research, reviews, and guidelines. POCUS applications varied across cardiovascular, pulmonary, neurological, and abdominal assessments. Key benefits included a reduced need for invasive procedures and rapid bedside diagnosis. Challenges included steep learning curves for clinicians and the need for standardized training and guidelines. Educational strategies highlighted the effectiveness of simulation-based training in enhancing ultrasound proficiency among neonatal care providers. POCUS represents a significant advancement in neonatal medicine, offering benefits for patient care. Addressing identified challenges through comprehensive training programs and developing standardized guidelines is crucial for optimized use. Future research should focus on evaluating educational outcomes and long-term impacts of POCUS integration into neonatal care.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany;
| | - Agnes Wittek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Lone Winter
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
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Kaya B, Dilli D, Sarikaya Y, Akduman H, Citli R, Orun UA, Tasar M, Zenciroglu A. Lung ultrasound in the evaluation of pulmonary edema in newborns with critical congenital heart disease. Pediatr Neonatol 2024:S1875-9572(24)00039-1. [PMID: 38514358 DOI: 10.1016/j.pedneo.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Newborns with critical congenital heart disease (CCHD) with increased pulmonary blood flow (PBF) are at high risk for congestive heart failure. In this study, we aimed to evaluate the presence and degree of pulmonary edema in newborns with CCHD using lung ultrasound (LUS) during the perioperative period. METHODS Prospective clinical trial, 44 newborn patients with CCHD were evaluated in this prospective clinical trial. LUS was repeatedly performed to determine the course of pulmonary edema during the perioperative period. LUS was performed simultaneously with chest radiography (CXR), which was the main part of patient management. The primary outcome of this study was to identify whether a correlation existed between LUS and CXR findings. The secondary outcomes were to determine the relationship between LUS and the need for respiratory support, diuretic use, vasoactive inotropic score (VIS), and pro-B-type natriuretic peptide (pro-BNP) levels during the perioperative period. RESULTS The mean gestational age of the patients was 38.3 ± 1.7 weeks, with a mean birth weight of 3026 ± 432 g. In the preoperative period, both LUS and CXR images were consistent with clinical signs of pulmonary edema. On the first postoperative day, pulmonary edema increased compared to the preoperative period but gradually decreased by the 6th day of surgery (p < 0.05). Positive correlations were observed between the LUS and CXR findings at all study points (p < 0.05). The LUS findings exhibited trends parallel to those of VIS, serum pro-BNP levels, need for respiratory support, and diuretic requirements. As expected, these trends were more pronounced in CCHDs where PBF increased. CONCLUSION In CCHD, serial lung ultrasound (LUS) assessments, particularly in cases with increased PBF, can provide valuable guidance for managing patients during the perioperative period.
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Affiliation(s)
- Basak Kaya
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey.
| | - Dilek Dilli
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
| | - Yasin Sarikaya
- Dr. Sami Ulus Maternity and Child Research and Training Hospital Department of Radiology, Ankara, Turkey
| | - Hasan Akduman
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
| | - Rumeysa Citli
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
| | - Utku A Orun
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Pediatric Cardiology, Ankara, Turkey
| | - Mehmet Tasar
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Pediatric Cardiovascular Surgery, Ankara, Turkey
| | - Aysegul Zenciroglu
- Dr. Sami Ulus Maternity and Child Research and Training Hospital, Department of Neonatology, Ankara, Turkey
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Nobile S, Raimondi F. Editorial: Applications of lung ultrasound in neonatology and pediatrics. Front Pediatr 2024; 12:1370969. [PMID: 38361998 PMCID: PMC10867320 DOI: 10.3389/fped.2024.1370969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Affiliation(s)
- Stefano Nobile
- Neonatal Intensive Care Unit, Department of Mother, Child and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Raimondi
- Neonatal Intensive Care Unit, Department of Translational Medical Sciences, Università “Federico II” di Napoli, Naples, Italy
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Alexopoulou E, Prountzos S, Raissaki M, Mazioti A, Caro-Dominguez P, Hirsch FW, Lovrenski J, Ciet P. Imaging of Acute Complications of Community-Acquired Pneumonia in the Paediatric Population-From Chest Radiography to MRI. CHILDREN (BASEL, SWITZERLAND) 2024; 11:122. [PMID: 38255434 PMCID: PMC10814200 DOI: 10.3390/children11010122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024]
Abstract
The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or have hospital-acquired pneumonia. This review discusses the imaging findings for acute CAP complications and the diagnostic role of each imaging modality. Pleural effusion, empyema, necrotizing pneumonia, abscess, pneumatocele, pleural fistulas, and paediatric acute respiratory distress syndrome (PARDS) are acute CAP complications. When evaluating complicated CAP patients, chest radiography, lung ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used, with each having their own pros and cons. Imaging is usually not needed for CAP diagnosis, but it is essential for complicated cases and follow-ups. Lung ultrasound can supplement chest radiography (CR), which starts the diagnostic algorithm. Contrast-enhanced computed tomography (CECT) is used for complex cases. Advances in MRI protocols make it a viable alternative for diagnosing CAP and its complications.
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Affiliation(s)
- Efthymia Alexopoulou
- 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.A.); (A.M.)
| | - Spyridon Prountzos
- 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.A.); (A.M.)
| | - Maria Raissaki
- University Hospital of Heraklion, Medical School, University of Crete, 70013 Heraklion, Greece;
| | - Argyro Mazioti
- 2nd Department of Radiology, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece; (E.A.); (A.M.)
| | - Pablo Caro-Dominguez
- Pediatric Radiology Unit, Radiology Department, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Seville, Spain;
| | - Franz Wolfgang Hirsch
- Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107 Leipzig, Germany;
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Pierluigi Ciet
- Department of Radiology and Nuclear Medicine, Erasmus MC—Sophia Children’s Hospital, 3015 CN Rotterdam, The Netherlands;
- Department of Radiology, University of Cagliari, 09124 Cagliari, Italy
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