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Liu J, Chi JH, Lu ZL, Fu W. The specific signs of lung ultrasound to diagnose pulmonary hemorrhage of the newborns: Evidence from a multicenter retrospective case-control study. Front Pediatr 2023; 11:1090332. [PMID: 36743886 PMCID: PMC9890160 DOI: 10.3389/fped.2023.1090332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Pulmonary hemorrhage (PH) is one kind of critical lung diseases in newborn infants, which is the most difficult one to be diagnosed by ultrasound. This study was to investigate the specific ultrasonic signs of PH in order to better diagnose neonatal PH by using lung ultrasound (LUS). METHODS A total 168 newborn infants were enrolled in this study, which included PH, pneumonia, meconium aspiration syndrome, and newborns without lung diseases, there were 42 cases in each group. In a quiet state, infants were placed in the supine, lateral or prone position for the examination. Each lung was divided into the anterior, lateral and posterior regions, then each region of both lungs was scanned with the probe perpendicular to the ribs or parallel to the Intercostal spaces. RESULTS The major results showed that: (1) the common LUS manifestation of PH includes lung consolidation, air bronchograms, fluid bronchograms, pleural effusion, shred signs, pleural line abnormality and B-lines, while fibrin deposition sign is a rare sign of PH. (2) Co-existing of lung consolidation with fluid bronchograms and pleural effusion is the specific sign of PH with a sensitivity of 81.0%, specificity of 98.4% and the positive predictive value (PPV) was 94.4%. (3) Fibrin deposition sign is an uncommon specific LUS sign of PH with a sensitivity 28.6%, specificity of 100% and the PPV was 100%. (4) Nine patients (21.4%) were diagnosed with PH based on ultrasound findings before oronasal bleeding. (5) The survival rate of infants with PH was 100% in this study. CONCLUSION LUS is helpful for the early diagnosis of neonatal PH and may therefore improve the prognosis. The lung consolidation with fluid bronchograms and pleural effusion as well as fibrin deposition sign are specific to diagnose PH by using LUS.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jing-Han Chi
- Department of Pediatric Medicine, the Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zu-Lin Lu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
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3
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Cho HJ, Kim EJ, Son DW. Neonatologist-Performed Cranial Ultrasonography in the Neonatal Intensive Care Unit. NEONATAL MEDICINE 2022. [DOI: 10.5385/nm.2022.29.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Cranial ultrasound (CUS) is an initial screening imaging tool used to evaluate the neonatal brain. It is an accessible, inexpensive, and harmless technique that can be used at bedside as frequently as required. Timely focused CUS in the neonatal care unit can play a major role in the diagnosis, follow-up, and management of brain damage. Despite the increasing use of point-of-care ultrasonography by intensive care physicians, neonatologist-performed CUS remains unusual. This review aims to provide an overview of neonatal CUS to neonatologists, focusing on the optimal settings, standard planes of the brain, and main pathologies in preterm infants. Adding Doppler studies allows evaluation of the patency of intracranial arteries and veins, flow velocities, and indices. This may provide an opportunity for earlier targeted circulatory support to prevent brain injury and improve long-term neurodevelopmental outcomes.
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Meggitt A, Way DP, Iyer MS, Mahan JD, Gold D. Residents' Perspective on Need for Point-of-Care Ultrasound Education During Pediatric Residency. Hosp Pediatr 2022; 12:607-617. [PMID: 35510494 DOI: 10.1542/hpeds.2021-006444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many medical disciplines incorporate point-of-care ultrasound (POCUS) into their practice. Despite well-defined applications, POCUS has not been widely adopted in pediatrics and is not commonly taught during residency. Our objective was to profile the current state of POCUS education in pediatric residency training from the resident perspective. METHODS We surveyed pediatric trainees about their POCUS education, general opinions about POCUS, and perceived barriers to POCUS training in residency. We distributed the survey to a random sample of Ohio pediatric residents, stratified by program size and training level. Descriptive statistics were used to characterize responses. RESULTS We sampled 66.4% of the population (371 of 559) of Ohio pediatric residents and achieved a response rate of 59.3%. Only 15% of respondents received POCUS training during residency, with 85% having never performed a POCUS scan. Most (86%) desired POCUS education and 67% believed it should be required during residency. Residents felt that POCUS would be useful for procedural guidance (95%), clinical diagnosis (94%), and patient safety (74%). Most residents (61%) believed POCUS education would benefit their careers, particularly those planning on subspecialization. Barriers to POCUS education included lack of an established curriculum (75%), competing educational priorities (58%), and a shortage of qualified instructors (52%). CONCLUSIONS Although Ohio pediatric residents do not receive formal POCUS education in residency, they desire such training and believe it would benefit their future practice. Consensus on scope of practice, development of a standardized curriculum, and increased faculty training in POCUS may help address this educational gap.
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Affiliation(s)
- Austin Meggitt
- University of Colorado, Anschutz Medical Campus, Denver, Colorado
| | - David P Way
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Maya S Iyer
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Delia Gold
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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Liu J, Guo G, Kurepa D, Volpicelli G, Sorantin E, Lovrenski J, Alonso-Ojembarrena A, Hsieh KS, Lodha A, Yeh TF, Jagła M, Shah H, Yan W, Hu CB, Zhou XG, Guo RJ, Cao HY, Wang Y, Zong HF, Shang LL, Ma HR, Liu Y, Fu W, Shan RY, Qiu RX, Ren XL, Copetti R, Rodriguez-Fanjul J, Feletti F. Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination. J Matern Fetal Neonatal Med 2022; 35:1003-1016. [PMID: 34182870 DOI: 10.1080/14767058.2021.1940943] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung ultrasound (LUS) is now widely used in the diagnosis and monitor of neonatal lung diseases. Nevertheless, in the published literatures, the LUS images may display a significant variation in technical execution, while scanning parameters may influence diagnostic accuracy. The inter- and intra-observer reliabilities of ultrasound exam have been extensively studied in general and in LUS. As expected, the reliability declines in the hands of novices when they perform the point-of-care ultrasound (POC US). Consequently, having appropriate guidelines regarding to technical aspects of neonatal LUS exam is very important especially because diagnosis is mainly based on interpretation of artifacts produced by the pleural line and the lungs. The present work aimed to create an instrument operation specification and parameter setting guidelines for neonatal LUS. Technical aspects and scanning parameter settings that allow for standardization in obtaining LUS images include (1) select a high-end equipment with high-frequency linear array transducer (12-14 MHz). (2) Choose preset suitable for lung examination or small organs. (3) Keep the probe perpendicular to the ribs or parallel to the intercostal space. (4) Set the scanning depth at 4-5 cm. (5) Set 1-2 focal zones and adjust them close to the pleural line. (6) Use fundamental frequency with speckle reduction 2-3 or similar techniques. (7) Turn off spatial compounding imaging. (8) Adjust the time-gain compensation to get uniform image from the near-to far-field.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Guo Guo
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
- Department of Neonatology, The Fifth Medical Center of Chinese of PLA General Hospital, Beijing, China
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New York, NY, USA
| | - Giovanni Volpicelli
- Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Torino, Italy
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Jovan Lovrenski
- Radiology Department, Faculty of Medicine, Institute for Children and Adolescents Health Care of Vojvodina, University of Novi Sad, Novi Sad, Serbia
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Shuangho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Abhay Lodha
- Department of Pediatrics & Community Health Sciences, University of Calgary, Foothills Medical Centre, Calgary, NW, Canada
| | - Tsu F Yeh
- Division of Neonatology, Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
| | - Mateusz Jagła
- Department of Pediatrics, University Children's Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Heli Shah
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Cohen Children's Medical Center, New York, NY, USA
| | - Wei Yan
- Department of Ultrasound, Zhumadian Center Hospital, Zhumadian City, China
| | - Cai-Bao Hu
- Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
| | - Xiao-Guang Zhou
- Neonatal Medical Center, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Rui-Jun Guo
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hai-Ying Cao
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Yan Wang
- Department of Neonatology and NICU, Tai'an Central Hospital of Shandong Province, Taian City, China
| | - Hai-Feng Zong
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Li-Li Shang
- Department of Neonatology and NICU, Huizhou Central Hospital of Guangdong Province, Huizhou City, China
| | - Hai-Ran Ma
- Department of Intensive Care Unit, The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Haerbin, China
| | - Ying Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Rui-Yan Shan
- Department of Neonatology, Yantai Yuhuangding Hospital Affiliated to Qingdao University School of Medicine, Yantai, Shandong Province, China
| | - Ru-Xin Qiu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Healthcare Hospital, Beijing, China
- The National Neonatal Lung Ultrasound Training Center, Chinese College of Critical Ultrasound & the World Interactive Network Focused On Critical Ultrasound China branch, Beijing, China
| | - Roberto Copetti
- Department of Emergency, University Hospital of Cattinara, Trieste, Italy
| | | | - Francesco Feletti
- Unit of Radiology, Ospedale S. Maria delle Croci Ravenna, Ausl Romagna, Ravenna, Italy
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Zheng Y, Gandhi A, Sewell K, Tumin D, Bear K. Point-of-care ultrasound educational interventions in the neonatal intensive care unit: A systematic review. J Neonatal Perinatal Med 2022; 15:511-520. [PMID: 35491808 DOI: 10.3233/npm-210925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The benefits of point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) have been widely recognized, but education on this area of practice remains variable. We reviewed published educational interventions regarding POCUS use in the NICU and whether they have led to sustainable increases in POCUS use. METHODS A systematic search of 6 databases was performed for publications from January 2000 to March 2021. Studies with quantitative data related to POCUS educational interventions in the NICU were included. Data on number of participants and roles, educational intervention, curriculum description, and project outcome measures (including sustainability) was extracted. RESULTS The search resulted in 686 articles, of which nine studies met the inclusion criteria. Educational interventions included didactic sessions, simulation practice, animal practice, and practice in real patients. The most common assessment was based on the quality and accuracy of the images. At the participant level, the average time to reach proficiency ranged from eight hours and thirty-six minutes to five months, and none of the studies evaluated sustainability of POCUS use after the intervention. CONCLUSION There is a lack of standardized training modules and assessments for POCUS use in the NICU. Given that none of the studies addressed sustainability or standardized training, we recommend that a standardized training protocol and assessment tool is developed and studied longitudinally; and that barriers to sustainable POCUS use in the NICU (such as billing issues and a lack of POCUS machines and instructors) be systematically addressed as part of this work.
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Affiliation(s)
- Y Zheng
- Department of Pediatrics, East Carolina University and Vidant Medical Center, Greenville, NC, USA
| | - A Gandhi
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Sewell
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - D Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - K Bear
- Department of Neonatology, Vidant Medical Center, Greenville, NC, USA
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Brant JA, Orsborn J, Good R, Greenwald E, Mickley M, Toney AG. Evaluating a longitudinal point-of-care-ultrasound (POCUS) curriculum for pediatric residents. BMC MEDICAL EDUCATION 2021; 21:64. [PMID: 33468138 PMCID: PMC7816421 DOI: 10.1186/s12909-021-02488-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/01/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND POCUS is a growing field in medical education, and an imaging modality ideal for children given the lack of ionizing radiation, ease of use, and good tolerability. A 2019 literature review revealed that no US pediatric residency programs integrated obligatory POCUS curricula. Our objective was to provide a formalized POCUS curriculum over multiple years, and to retrospectively assess improvement in resident skills and comfort. METHODS During intern year, pediatric residents received didactics and hands-on scanning opportunities in basic POCUS applications. Their evaluation tools included pre- and post-surveys and tests, and a final performance exam. In the second and third years of residency, all participants were required to complete 8 hours per year of POCUS content review and additional hands-on training. An optional third-year curriculum was offered to interested residents as career-focused education elective time. RESULTS Our curriculum introduced POCUS topics such as basic and advanced cardiac, lung, skin/soft tissues and procedural based ultrasound to all pediatric residents. Among first-year residents, application-specific results showed POCUS comfort level improved by 61-90%. Completed evaluations demonstrated improvement in their ability to recognize and interpret POCUS images. Second- and third-year residents reported educational effectiveness that was rated 3.9 on a 4-point Likert scale. Four third-year residents took part in the optional POCUS elective, and all reported a change in their practice with increased POCUS incorporation. CONCLUSIONS Our longitudinal pediatric residency POCUS curriculum is feasible to integrate into residency training and exhibits early success.
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Affiliation(s)
- Julia Aogaichi Brant
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA.
| | - Jonathan Orsborn
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Ryan Good
- Department of Pediatrics, Section of Pediatric Intensive Care, University of Colorado/Children's Hospital Colorado, Aurora, CO, USA
| | - Emily Greenwald
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Megan Mickley
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Amanda G Toney
- Department of Pediatrics, Denver Health Medical Center, Denver, CO, USA
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