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Silveira Neves G, Silveira Nogueira Reis Z, Maia de Castro Romanelli R, dos Santos Nascimento J, Dias Sanglard A, Batchelor J. The role of chest X-ray in the diagnosis of neonatal respiratory distress syndrome: a systematic review concerning low-resource birth scenarios. Glob Health Action 2024; 17:2338633. [PMID: 38660779 PMCID: PMC11047214 DOI: 10.1080/16549716.2024.2338633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Access to diagnostic tools like chest radiography (CXR) is challenging in resource-limited areas. Despite reduced reliance on CXR due to the need for quick clinical decisions, its usage remains prevalent in the approach to neonatal respiratory distress syndrome (NRDS). OBJECTIVES To assess CXR's role in diagnosing and grading NRDS severity compared to current clinical features and laboratory standards. METHODS A review of studies with NRDS diagnostic criteria was conducted across six databases (MEDLINE, EMBASE, BVS, Scopus-Elsevier, Web of Science, Cochrane) up to 3 March 2023. Independent reviewers selected studies, with discrepancies resolved by a senior reviewer. Data were organised into descriptive tables to highlight the use of CXR and clinical indicators of NRDS. RESULTS Out of 1,686 studies screened, 23 were selected, involving a total of 2,245 newborns. All selected studies used CXR to diagnose NRDS, and 21 (91%) applied it to assess disease severity. While seven reports (30%) indicated that CXR is irreplaceable by other diagnostic tools for NRDS diagnosis, 10 studies (43%) found that alternative methods surpassed CXR in several respects, such as severity assessment, monitoring progress, predicting the need for surfactant therapy, foreseeing Continuous Positive Airway Pressure failure, anticipating intubation requirements, and aiding in differential diagnosis. CONCLUSION CXR remains an important diagnostic tool for NRDS. Despite its continued use in scientific reports, the findings suggest that the study's outcomes may not fully reflect the current global clinical practices, especially in low-resource settings where the early NRDS approach remains a challenge for neonatal survival.Trial registration: PROSPERO number CRD42022336480.
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Affiliation(s)
- Gabriela Silveira Neves
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | - Roberta Maia de Castro Romanelli
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | | | - André Dias Sanglard
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | - James Batchelor
- Clinical Informatics and Healthcare Innovation, Faculty of Medicine, University of Southampton, Southampton, UK
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Nabati M, Parsaee H. Combined use of double Doppler Tei index and lung ultrasound for predicting pulmonary hypertension and corpulmonale in neonates with respiratory distress. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:636-638. [PMID: 37125737 DOI: 10.1002/jcu.23378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 05/03/2023]
Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Cardiovascular Research Center, Sari, Iran
| | - Homa Parsaee
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Lung Ultrasound in the Early Diagnosis and Management of the Mild Form of Meconium Aspiration Syndrome: A Case Report. Diagnostics (Basel) 2023; 13:diagnostics13040719. [PMID: 36832209 PMCID: PMC9955577 DOI: 10.3390/diagnostics13040719] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
MAS is a common cause of neonatal respiratory distress in term and post-term neonates. Meconium staining of the amniotic fluid occurs in about 10-13% of normal pregnancies, and about 4% of these infants develop respiratory distress. In the past, MAS was diagnosed mainly on the basis of history, clinical symptoms, and chest radiography. Several authors have addressed the ultrasonographic assessment of the most common respiratory patterns in neonates. In particular, MAS is characterised by a heterogeneous alveolointerstitial syndrome, subpleural abnormalities with multiple lung consolidations, characterised by a hepatisation aspect. We present six cases of infants with a clinical history of meconium-stained fluid who presented with respiratory distress at birth. Lung ultrasound allowed the diagnosis of MAS in all the studied cases, despite the mild clinical picture. All children had the same ultrasound pattern with diffuse and coalescing B-lines, pleural line anomalies, air bronchograms, and subpleural consolidations with irregular shapes. These patterns were distributed in different areas of the lungs. These signs are specific enough to distinguish between MAS and other causes of neonatal respiratory distress, allowing the clinician to optimise therapeutic management.
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Wang Y, Li N, Qu Y. Diagnostic accuracy of lung ultrasound for transient tachypnea: a meta-analysis. J Pediatr (Rio J) 2022; 98:329-337. [PMID: 34801486 PMCID: PMC9432068 DOI: 10.1016/j.jped.2021.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of this meta-analysis was to study the diagnostic value of lung ultrasound (LUS) for transient tachypnea of the newborn (TTN). METHODS Embase, Cochrane Library, PubMed, Web of Science, and Google Scholar were searched, and the last search date was October 31, 2020. Studies on the diagnostic accuracy of pulmonary ultrasound for transient tachypnea were included. The quality assessment of the included study was assessed using the Diagnostic Accuracy Studies-2 tool. A meta-analysis was performed using Meta-Disc 1.4. A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity. RESULTS A total of 378 articles were retrieved and nine studies with 3239 patients were included in the present meta-analysis. The overall quality of the included studies was moderate to high. The result of threshold analysis shows that there was no threshold effect. However, there was a significant heterogeneity caused by non-threshold effects in the included studies. A random-effects model was used. The pooled sensitivity, specificity, PLR and NLR were 0.55 (95% CI: 0.51-0.58), 0.98 (95% CI: 0.98-0.99), 58.30 (95% CI: 14.05-241.88) and 0.28 (95% CI: 0.18-0.43). The pooled DOR and AUC were 689.12 (95% CI: 68.71 to 6911.79) and 0.994. The results of subgroup analysis showed that the LUS diagnostic criteria and gold standard might be responsible for heterogeneity. Choosing "DLP combined with B line" as the diagnostic standard of LUS and choosing CXR as the gold standard could significantly improve the diagnostic performance of LUS. CONCLUSION LUS is a promising method to diagnose TTN. Only DLP is not enough to diagnose TTN, while DLP combined with B-line has good diagnostic performance.
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Affiliation(s)
- Yueqi Wang
- The First Hospital of Jilin University, Department of Neonatology, Jilin, China
| | - Na Li
- The First Hospital of Jilin University, Department of Neonatology, Jilin, China.
| | - Yangming Qu
- The First Hospital of Jilin University, Department of Neonatology, Jilin, China
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Ma HR, Liu J, Yan WK. Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review. Am J Perinatol 2022; 39:973-979. [PMID: 33242910 DOI: 10.1055/s-0040-1721134] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. STUDY DESIGN We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. RESULTS Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92-1.00) and a specificity of 0.99 (CI: 0.91-1.00). The area under the curve for LUS was 1.00 (0.98-1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. CONCLUSION The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. KEY POINTS · Lung ultrasound is a highly accurate diagnostic tool, which may be a viable and superior alternative to CXR, in diagnosing TTN.. · Lung ultrasound can help differentiate TTN from other etiologies of respiratory distress in neonates.. · There are still some controversies on the ultrasound diagnostic criteria of TTN..
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Affiliation(s)
- Hai-Ran Ma
- Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou Guangdong, Republic of China
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing and National Neonatal Lung Ultrasound Training Center, Beijing, Republic of China
| | - Jing Liu
- Department of Neonatology and Neonatal Intensive Care Unit, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing and National Neonatal Lung Ultrasound Training Center, Beijing, Republic of China
| | - Wen-Kang Yan
- Department of Neonatology and Neonatal Intensive Care Unit, Huizhou Municipal Central Hospital, Huizhou Guangdong, Republic of China
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He L, Sun Y, Sheng W, Yao Q. Diagnostic performance of lung ultrasound for transient tachypnea of the newborn: A meta-analysis. PLoS One 2021; 16:e0248827. [PMID: 33780485 PMCID: PMC8006999 DOI: 10.1371/journal.pone.0248827] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/07/2021] [Indexed: 12/13/2022] Open
Abstract
Several recent studies demonstrated that lung ultrasound could achieve desired diagnostic accuracy for transient tachypnea of the neonate (TTN). However, the diagnostic performance of lung ultrasound for TTN has not been systematically studied to date. This meta-analysis aimed to investigate the performance of lung ultrasound in diagnosing TTN. The relevant literature was searched in PubMed, Medline, the Cochrane Library, and Embase databases without any restriction in terms of language and time until January 31, 2021. Studies that assessed the diagnostic performance of lung ultrasound for TTN were included. Seven studies with 1514 participants were summarized. The lung ultrasound provided more accurate performance for diagnosing TTN with pooled sensitivity and specificity of 0.67 [95% confidence interval (CI) = 0.63–0.71] and 0.97 (95% CI = 0.95–0.98), respectively. A higher summarized area under the summary receiver operating characteristic curve was observed as 0.9906. Lower sensitivity and area under the curve (AUC) of B-lines for TTN were observed as 0.330 (95% CI = 0.27–0.38) and 0.5000, respectively. Lung ultrasound provided highly accurate AUC, sensitivity, and specificity in detecting TTN. Large-scale studies are warranted in the future to confirm these results.
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Affiliation(s)
- Lili He
- Department of Ultrasound, Children’s Hospital of Fudan University, Shanghai, China
| | - Yinghua Sun
- Department of Ultrasound, Children’s Hospital of Fudan University, Shanghai, China
| | - Wei Sheng
- Institute of Pediatrics, Children’s Hospital of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Shanghai, China
- * E-mail: (WS); (YQ)
| | - Qiong Yao
- Department of Radiology, Children’s Hospital of Fudan University, Shanghai, China
- * E-mail: (WS); (YQ)
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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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Li CS, Chu SM, Lien R, Mok TY, Hsu KH, Lai SH. Prospective investigation of serial ultrasound for transient tachypnea of the newborn. Pediatr Neonatol 2021; 62:64-69. [PMID: 32972849 DOI: 10.1016/j.pedneo.2020.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/08/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Transient tachypnea of the newborn (TTN), which is diagnosed using typical clinical course and radiographic findings, is the most common cause of respiratory distress in late-preterm and term neonates. Lung ultrasound (LUS) is increasingly used to identify TTN according to the distinct characteristics of the disease. However, few studies have reported the application of LUS to monitor the clinical evolution of TTN. Using serial LUS, this prospective study assessed and monitored TTN severity. METHODS From November 2018 to October 2019, neonates ≥34 weeks of gestation admitted to the newborn center of Chang Gung Memorial Hospital were enrolled. Neonates diagnosed with TTN and requiring respiratory support comprised the TTN group (n = 29), whereas those without respiratory disease served as the control group (n = 23). LUS was performed and scored in both groups within 4 h of admission and followed up at 24 and 48 h. RESULTS A total of 65 infants were screened for enrollment and 13 were excluded. Most of the enrollees in both groups exhibited a peak LUS score on the first day, which then gradually declined thereafter. In comparison with the control group, the LUS score of the TTN group was higher on day 1 and day 2, and it had a significantly greater decrease from day 1 to day 2. In the TTN group, LUS scores moderately correlated with respiratory severity scores. CONCLUSION We conducted a serial and quantitative LUS investigation in late-preterm and term infants with TTN. The LUS score mirrored the respiratory status relatively well, and it can help to monitor the clinical course of TTN, in the case of either resolution or deterioration.
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Affiliation(s)
- Chung-Sing Li
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Tze-Yee Mok
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC
| | - Shen-Hao Lai
- Division of Chest, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, ROC.
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