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Briana D, Malamitsi-Puchner A, Di Renzo GC. Using ultrasound instead of X-ray to diagnose neonatal lung disease: an important milestone in the development of neonatal medicine. J Matern Fetal Neonatal Med 2024; 37:2311097. [PMID: 38326279 DOI: 10.1080/14767058.2024.2311097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Despina Briana
- NICU, 3rd Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
- Permanent International and European School of Perinatal and Reproductive Medicine, Florence, Italy
- Department of Obstetrics and Gynecology, The I. M. Sechenov First State University of Moscow, Moscow, Russia
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Liu J, Gao YQ, Fu W. Ultrasound findings and specific intrinsic blood volume expansion therapy for neonatal capillary leak syndrome: report from a multicenter prospective self-control study. Eur J Med Res 2024; 29:150. [PMID: 38429824 PMCID: PMC10908005 DOI: 10.1186/s40001-024-01738-2] [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: 10/05/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE Capillary leak syndrome (CLS) is characterized by severe systemic edema without specific treatment, resulting in a high mortality rate. This study investigated whether there is organ edema in neonatal CLS patients and specific treatment strategies to improve patient prognosis. METHODS Thirty-seven newborns diagnosed with CLS were included in this study. (1) Routine point-of-care ultrasound (POCUS) was used to identify whether the patients had visceral edema or fluid collection. (2) All patients were treated with 3% NaCl intravenously, and the clinical manifestations, laboratory indices and outcomes were compared before and after treatment. RESULTS (1) Diffuse severe edema was found in 92.0% of the patients. (2) The POCUS examination revealed that CLS patients exhibited significant visceral edema in addition to diffuse severe edema, which included pulmonary edema in 67.6%, cerebral edema in 37.8%, severe intestinal edema in 24.3%, severe myocardial edema in 8.1%, pericardial effusion in 5.4%, pleural effusion in 29.7% and peritoneal effusion in 18.9%. Two patients (5.45%) had only myocardial edema without other manifestations. (3) Before and after the intravenous injection of 3% NaCl, there were no significant differences in the serum sodium or potassium levels of CLS patients, while the hemoglobin and hematocrit levels were significantly lower after treatment (p < 0.01). Her plasma ALB concentration and arterial pressure returned to normal levels after the treatment was completed. (4) All the patients survived, and no side effects or complications were observed during or after treatment with 3% NaCl. CONCLUSIONS (1) In addition to diffuse severe edema, visceral edema and effusion are common and important clinical manifestations of neonatal CLS and need to be detected by routine POCUS. (2) The intravenous injection of 3% NaCl is a safe, effective and specific treatment strategy for neonatal CLS, with a survival rate of 100% and no adverse effects.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China.
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Yue-Qiao Gao
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing, 100026, China
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Nemes AF, Toma AI, Dima V, Serboiu SC, Necula AI, Stoiciu R, Ulmeanu AI, Marinescu A, Ulmeanu C. Use of Lung Ultrasound in Reducing Radiation Exposure in Neonates with Respiratory Distress: A Quality Management Project. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:308. [PMID: 38399595 PMCID: PMC10890069 DOI: 10.3390/medicina60020308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/04/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm2 in 2021 to 3.76 Gy × cm2 in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases.
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Affiliation(s)
- Alexandra Floriana Nemes
- Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Adrian Ioan Toma
- Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Vlad Dima
- Department of Neonatology, Filantropia Hospital, 011132 Bucharest, Romania
| | - Sorina Crenguta Serboiu
- Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | | | - Roxana Stoiciu
- Department of Neonatology, Life Memorial Hospital, 010719 Bucharest, Romania
| | - Alexandru Ioan Ulmeanu
- Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Toxicology, Grigore Alexandrescu Children’s Hospital, 011743 Bucharest, Romania
| | - Andreea Marinescu
- Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Coriolan Ulmeanu
- Faculty of Medicine. Doctoral School, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Toxicology, Grigore Alexandrescu Children’s Hospital, 011743 Bucharest, Romania
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Liu J. Lung Ultrasonography Does Not Distinguish between Interstitial and Alveolar Pulmonary Edema. Diagnostics (Basel) 2024; 14:324. [PMID: 38337840 PMCID: PMC10855817 DOI: 10.3390/diagnostics14030324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
For a long time, lung diseases have been considered the "forbidden zone" for ultrasound diagnosis because the lung is filled with gas, and the ultrasound waves are totally reflected when they encounter gas [...].
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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5
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Abid I, Qureshi N, Lategan N, Williams S, Shahid S. Point-of-care lung ultrasound in detecting pneumonia: A systematic review. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:37-48. [PMID: 38299193 PMCID: PMC10830142 DOI: 10.29390/001c.92182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/09/2023] [Indexed: 02/02/2024]
Abstract
Purpose Limited evidence exists to assess the sensitivity, specificity, and accuracy of point-of-care lung ultrasound (LUS) across all age groups. This review aimed to investigate the benefits of point-of-care LUS for the early diagnosis of pneumonia compared to traditional chest X-rays (CXR) in a subgroup analysis including pediatric, adult, and geriatric populations. Material and Methods This systematic review examined systematic reviews, meta-analyses, and original research from 2017 to 2021, comparing point-of-care LUS and CXR in diagnosing pneumonia among adults, pediatrics and geriatrics. Studies lacking direct comparison or exploring diseases other than pneumonia, case reports, and those examining pneumonia secondary to COVID-19 variants were excluded. The search utilized PubMed, Google Scholar, and Cochrane databases with specific search strings. The study selection, conducted by two independent investigators, demonstrated an agreement by the Kappa index, ensuring reliable article selection. The QUADAS-2 tool assessed the selected studies for quality, highlighting risk of bias and applicability concerns across key domains. Statistical analysis using Stata Version 16 determined pooled sensitivity and specificity via a bivariate model, emphasizing LUS and CXR diagnostic capabilities. Additionally, RevMan 5.4.1 facilitated the calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), offering insights into diagnostic accuracy. Results The search, conducted across PubMed, Google Scholar, and Cochrane Library databases by two independent investigators, initially identified 1045 articles. Following screening processes, 12 studies comprised a sample size of 2897. LUS demonstrated a likelihood ratio of 5.09, a specificity of 81.91%, and a sensitivity of 92.13% in detecting pneumonia in pediatric, adult, and geriatric patients, with a p-value of 0.0002 and a 95% confidence interval, indicating diagnostic accuracy ranging from 84.07% to 96.29% when compared directly to CXR. Conclusion Our review supports that LUS can play a valuable role in detecting pneumonia early with high sensitivity, specificity, and diagnostic accuracy across diverse patient demographics, including pediatric, adult, and geriatric populations. Since it overcomes most of the limitations of CXR and other diagnostic modalities, it can be utilized as a diagnostic tool for pneumonia for all age groups as it is a safe, readily available, and cost-effective modality that can be utilized in an emergency department, intensive care units, wards, and clinics by trained respiratory care professionals.
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Affiliation(s)
- Iqra Abid
- Respiratory Therapy Services Sidra Medical and Research Center
| | - Nadia Qureshi
- Alberta Health Services Respiratory Health Section, Medicine Strategic Clinical Network
| | - Nicola Lategan
- Respiratory Therapy Services Sidra Medical and Research Center
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Liu J. [Management of lung diseases under ultrasound monitoring: potential to make bronchopulmonary dysplasia in preterm infants as an avoidable disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:14-18. [PMID: 38269453 PMCID: PMC10817729 DOI: 10.7499/j.issn.1008-8830.2309120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 01/26/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Despite significant progress in the understanding of its etiology, mechanisms, prevention, and treatment, the prognosis remains poor. BPD not only has a high mortality rate but also causes persistent respiratory, neurological, and cardiovascular impairments in survivors. The author's team has successfully prevented the occurrence of BPD by managing neonatal lung diseases under lung ultrasound monitoring for nearly 7 years, opening up a new approach in BPD prevention. This article provides a brief overview of the approach, aiming to facilitate further research and provide more scientifically sound management strategies to prevent or minimize the occurrence of BPD.
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Affiliation(s)
- Jing Liu
- Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China (liujingbj@sina. com)
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7
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Liu J. Ultrasound diagnosis and grading criteria of neonatal respiratory distress syndrome. J Matern Fetal Neonatal Med 2023; 36:2206943. [PMID: 37142428 DOI: 10.1080/14767058.2023.2206943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Background: Respiratory distress syndrome (RDS) is a common critical lung disease in newborn infants, especially those in premature infants with higher mortality rate. Early and correct diagnosis is the key to improve its prognosis. Previously, the diagnosis of RDS mainly relied on chest X-ray (CXR) findings, and it has been graded into four stages based on the progression and severity of CXR changes. This traditional diagnosing and grading method may lead to high misdiagnosis rate or delayed diagnosis. Recently, using ultrasound to diagnose neonatal lung diseases and RDS is becoming increasingly popular, and the technology is gaining higher sensitivity and higher specificity. The management of RDS under lung ultrasound (LUS) monitoring has achieved significant results, reducing the misdiagnosis rate of RDS, thereby reducing the probability of mechanical ventilation and the use of exogenous pulmonary surfactant, and making the success rate of treatment of RDS up to 100%.Objective: The purpose of the article was to introduce the ultrasound grading methods and criteria of RDS, in order to promote the application of LUS in the diagnosis and treatment of RDS.Methods: Literature (in English and Chinese) on the use of ultrasound in the diagnosis of neonatal RDS between 2008 and 2022 was selected for inclusion in this study.Results: From the collected literature, the use of ultrasound in the diagnosis of RDS is increasing, and people's understanding of the ultrasound imaging findings of RDS is also changing. Among them, the research on ultrasound grading of RDS is the latest progress.Conclusion: Ultrasound is accurate and reliable in the diagnosis and differential diagnosis of RDS. It is of great clinical value to master the ultrasound diagnosis and grading criteria of RDS.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Liu J, Zhang X, Wang Y, Li J, Yan W, Qin SJ, Ren XL, Fu W. The Outcome- or Cost-Effectiveness Analysis of LUS-Based Care or CXR-Based Care of Neonatal Lung Diseases: The Clinical Practice Evidence from a Level Ⅲ NICU in China. Diagnostics (Basel) 2022; 12:diagnostics12112790. [PMID: 36428848 PMCID: PMC9689125 DOI: 10.3390/diagnostics12112790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/13/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare the effect of managing neonatal lung disease with lung ultrasound (LUS) or chest X-ray (CXR) monitoring on health outcomes and cost-effectiveness. METHODS The data obtained from the NICU of the Beijing Chaoyang District Maternal and Child Healthcare Hospital were used as the study group, as LUS has completely replaced CXR in managing newborn lung disease in the hospital for the past 5 years. The primary outcomes of this study were the misdiagnosis rate of respiratory distress syndrome (RDS), the using status of mechanical ventilation, the incidence rate of bronchopulmonary dysplasia (BPD) and the survival rate in hospitalized infants. The secondary outcomes included the use pulmonary surfactant (PS), and the mortality rate of severe diseases (such as pneumothorax, pulmonary hemorrhage and RDS, etc.). RESULTS Managing neonatal lung disease with LUS monitoring may enable the following effects: The frequency of ventilator use reducing by 40.2%; the duration of mechanical ventilation reducing by 67.5%; and the frequency of ventilator weaning failure being totally avoided. A misdiagnosis rate of 30% for RDS was also avoided. The dosage of PS was significantly reduced by 50% to 75%. No BPD occurred in the LUS-based care group for 5 years. The fatality rates of RDS, pneumothorax and pulmonary hemorrhage decreased by 100%. The poor prognosis rate of VLBW infants decreased by 85%, and the total mortality rate of hospitalized infants decreased by 90%. Therefore, the cost of LUS-based care was inevitably saved. CONCLUSIONS Diagnosing and managing neonatal lung diseases with LUS monitoring have significant benefits, and this technology should be widely promoted and applied around the world.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Correspondence:
| | - Xin Zhang
- Department of Neonatology and NICU, Zhumadian Central Hospital of Henan Province, Zhumadian 463003, China
| | - Yan Wang
- Department of Neonatology and NICU, The Affiliated Taian City Central Hospital of Qingdao University, Taian 271000, China
| | - Jie Li
- Department of Neonatology and NICU, Zaozhuang Maternal and Child Healthcare Hospital of Shandong Province, Zaozhuang 277100, China
| | - Wei Yan
- Department of Ultrasound, Zhumadian Central Hospital of Henan Province, Zhumadian 463003, China
| | - Sheng-Juan Qin
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing 100021, China
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Lung Ultrasound Monitoring of Legionella Ventilator-Associated Pneumonia in an Extremely Low-Birth-Weight Infant. Diagnostics (Basel) 2022; 12:diagnostics12092253. [PMID: 36140654 PMCID: PMC9497615 DOI: 10.3390/diagnostics12092253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Ventilator-associated pneumonia (VAP) is a common complication of different severe lung diseases that need to be treated with mechanical ventilation in newborn infants. However, VAP due to Legionella pneumophila infection is rarely reported in the literature, especially in extremely low-birth-weight (ELBW) infants. Lung ultrasound (LUS) has been used in the diagnosis of neonatal pneumonia, but there is no literature on the ultrasound characteristics of Legionella-VAP in ELBW infants. This paper introduced the typical LUS findings of Legionella-VAP in ELBW infants, which mainly includes severe and large-area lung consolidation and atelectasis in the bilateral lungs; whether there is blood supply in the consolidated area has an important reference value for predicting the prognosis. In addition, the treatment and management experience were also introduced together, thereby helping us to deepen the understanding of the disease and avoid missed diagnoses.
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Lung Ultrasound to Diagnose Pneumonia in Neonates with Fungal Infection. Diagnostics (Basel) 2022; 12:diagnostics12081776. [PMID: 35892488 PMCID: PMC9331912 DOI: 10.3390/diagnostics12081776] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/04/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022] Open
Abstract
With the improvement in survival rates of low-birthweight and very premature infants, neonatal fungal infection, especially fungal pneumonia, is becoming more and more common, but the diagnosis is always challenging. Recently, lung ultrasound (LUS) has been used to diagnose pneumonia in newborn infants, but not fungal pneumonia. This paper summarizes the ultrasonographic features of seven cases of neonatal fungal pneumonia, such as lung consolidation with air bronchograms, shred signs, lung pulse, pleural line abnormalities, and different kinds of B-lines. It was confirmed that LUS plays an important role in the diagnosis of fungal pneumonia in newborn infants.
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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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Gregorio-Hernández R, Pérez-Pérez A, Alonso-Ojembarrena A, Arriaga-Redondo M, Ramos-Navarro C, Sánchez-Luna M. Neonatal pneumothoraces with atypical location: the role of lung ultrasound. Eur J Pediatr 2022; 181:1751-1756. [PMID: 34845527 DOI: 10.1007/s00431-021-04329-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/02/2023]
Abstract
UNLABELLED Neonatal pneumothorax (NP) is a potentially life-threatening condition. Lung ultrasound (LUS) has shown higher sensitivity and specificity in diagnosis compared to x-rays, but evidence regarding its usefulness in complex NP is lacking. We report four neonates suffering from cardiac or esophageal malformations who developed lateral and/or posterior pneumothoraces, in which LUS helped, making NP diagnosis and management easier and faster. CONCLUSION LUS is an easy-to-use, fast, simple, and accurate tool when evaluating newborns with NP, also in atypical positions such as in surgical patients. WHAT IS KNOWN • Lung ultrasound (LUS) has higher sensitivity and specificity than x-rays in the diagnosis of pneumothorax in neonatal patients. WHAT IS NEW • This is the first report about neonatal pneumothorax in non-conventional areas (lateral/posterior) diagnosed by lung ultrasound and how obtaining this information is critical in order to optimize management.
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Affiliation(s)
| | - Alba Pérez-Pérez
- Neonatology Department, Gregorio Marañón University Hospital, Madrid, Spain
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13
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Overview of Lung Ultrasound in Pediatric Cardiology. Diagnostics (Basel) 2022; 12:diagnostics12030763. [PMID: 35328316 PMCID: PMC8946933 DOI: 10.3390/diagnostics12030763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
Lung ultrasound (LUS) is increasing in its popularity for the diagnosis of pulmonary complications in acute pediatric care settings. Despite the high incidence of pulmonary complications for patients with pediatric cardiovascular and congenital heart disease, especially in children undergoing cardiac surgery, the use of LUS remains quite limited in these patients. The aim of this review is to provide a comprehensive overview and list of current potential applications for LUS in children with congenital heart disease, post-surgery. We herein describe protocols for LUS examinations in children, discuss diagnostic criteria, and introduce methods for the diagnosis and classification of pulmonary disease commonly encountered in pediatric cardiology (e.g., pleural effusion, atelectasis, interstitial edema, pneumothorax, pneumonia, and diaphragmatic motion analysis). Furthermore, applications of chest ultrasounds for the evaluation of the retrosternal area, and in particular, systematic search criteria for retrosternal clots, are illustrated. We also discussed the potential applications of LUS, including the guidance of interventional procedures, namely lung recruitment and drainage insertion. Lastly, we analyzed current gaps in knowledge, including the difficulty of the quantification of pleural effusion and atelectasis, and the need to differentiate different etiologies of B-lines. We concluded with future applications of LUS, including strain analysis and advanced analysis of diaphragmatic mechanics. In summary, US is an easy, accurate, fast, cheap, and radiation-free tool for the diagnosis and follow-up of major pulmonary complications in pediatric cardiac surgery, and we strongly encourage its use in routine practice.
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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: 27] [Impact Index Per Article: 13.5] [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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15
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Clofent D, Polverino E, Felipe A, Granados G, Arjona-Peris M, Andreu J, Sánchez-Martínez AL, Varona D, Cabanzo L, Escudero JM, Álvarez A, Loor K, Muñoz X, Culebras M. Lung Ultrasound as a First-Line Test in the Evaluation of Post-COVID-19 Pulmonary Sequelae. Front Med (Lausanne) 2022; 8:815732. [PMID: 35096906 PMCID: PMC8794580 DOI: 10.3389/fmed.2021.815732] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023] Open
Abstract
Background: Interstitial lung sequelae are increasingly being reported in survivors of COVID-19 pneumonia. An early detection of these lesions may help prevent the development of irreversible lung fibrosis. Lung ultrasound (LUS) has shown high diagnostic accuracy in interstitial lung disease (ILD) and could likely be used as a first-line test for post-COVID-19 lung sequelae. Methods: Single-center observational prospective study. Follow-up assessments of consecutive patients hospitalized for COVID-19 pneumonia were conducted 2–5 months after the hospitalization. All patients underwent pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and LUS. Radiological alterations in HRCT were quantified using the Warrick score. The LUS score was obtained by evaluating the presence of pathological B-lines in 12 thoracic areas (range, 0–12). The correlation between the LUS and Warrick scores was analyzed. Results: Three hundred and fifty-two patients who recovered from COVID-19 pneumonia were recruited between July and September 2020. At follow-up, dyspnea was the most frequent symptom (69.3%). FVC and DLCO alterations were present in 79 (22.4%) and 234 (66.5%) patients, respectively. HRCT showed relevant interstitial lung sequelae (RILS) in 154 (43.8%) patients (Warrick score ≥ 7). The LUS score was strongly correlated with the HRCT Warrick score (r = 0.77) and showed a moderate inverse correlation with DLCO (r = −0.55). The ROC curve analysis revealed that a LUS score ≥ 3 indicated an excellent ability to discriminate patients with RILS (sensitivity, 94.2%; specificity, 81.8%; negative predictive value, 94.7%). Conclusions: LUS could be implemented as a first-line procedure in the evaluation of Post-COVID-19 interstitial lung sequelae. A normal LUS examination rules out the presence of these sequelae in COVID-19 survivors, avoiding the need for additional diagnostic tests such as HRCT.
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Affiliation(s)
- David Clofent
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Eva Polverino
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Almudena Felipe
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Galo Granados
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Marta Arjona-Peris
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Andreu
- Radiology Department, Vall D'Hebron University Hospital, Barcelona, Spain
| | | | - Diego Varona
- Radiology Department, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Laura Cabanzo
- Radiology Department, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Jose M Escudero
- Radiology Department, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Antonio Álvarez
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Karina Loor
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Xavier Muñoz
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Mario Culebras
- Department of Respiratory Medicine, Vall D'Hebron University Hospital, Barcelona, Spain.,Vall D'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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16
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Guo BB, Pang L, Yang B, Zhang C, Chen XY, OuYang JB, Wu CJ. Lung Ultrasound for the Diagnosis and Management of Neonatal Respiratory Distress Syndrome: A Minireview. Front Pediatr 2022; 10:864911. [PMID: 35498779 PMCID: PMC9047941 DOI: 10.3389/fped.2022.864911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Lung ultrasound (LUS) is useful for diagnosis of respiratory distress syndrome in neonates. Recently, it has been proved to play an important role in the management of neonatal respiratory distress syndrome (RDS). It is feasible to grade RDS and select therapeutic modalities accordingly by LUS. The treatment also should be adjusted with the change in ultrasound images. In conclusion, LUS is valuable for the diagnosis and management of neonatal respiratory distress syndrome.
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Affiliation(s)
- Bin-Bin Guo
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Pang
- Department of Ultrasound, Harbin Finance University, Harbin, China
| | - Bo Yang
- Department of Ultrasound, Taian Maternal and Child Health Hospital of Shandong Province, Taian, China
| | - Cong Zhang
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Ya Chen
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia-Bao OuYang
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chang-Jun Wu
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
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17
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Deng B, Xu F, Li J, Mai M, Chen Q, Liao J, He X, Li N. Case Report: Lung Ultrasound in Critically Ill Neonates With Lung Diseases: Experience From Several Typical Cases. Front Pediatr 2022; 10:846279. [PMID: 35664870 PMCID: PMC9161147 DOI: 10.3389/fped.2022.846279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Lung ultrasound (LUS) can be used to diagnose various neonatal lung diseases. It more sensitively diagnoses pulmonary edema, pneumothorax, pulmonary consolidation, and atelectasis than traditional X-ray and quickly determines the cause of dyspnea. As a component of severe ultrasound, LUS enables rapid bedside visualization of lung diseases and plays a major role in guiding the differential diagnosis of disease, ventilator treatment, and lung recruitment. This study introduced the application of LUS in the diagnosis and treatment of critically ill neonates with lung diseases.
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Affiliation(s)
- Biying Deng
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Fengdan Xu
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Jinfeng Li
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Minling Mai
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Qin Chen
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Jinfeng Liao
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Xiaoguang He
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
| | - Ning Li
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, China
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18
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Wang J, Wei H, Chen H, Wan K, Mao R, Xiao P, Chang X. Application of ultrasonography in neonatal lung disease: An updated review. Front Pediatr 2022; 10:1020437. [PMID: 36389379 PMCID: PMC9640768 DOI: 10.3389/fped.2022.1020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Lung disease is often life-threatening for both preterm and term newborns. Therefore, an accurate and rapid diagnosis of lung diseases in newborns is crucial, as management strategies differ with different etiologies. To reduce the risk of radiation exposure derived from the conventionally used chest x-ray as well as computed tomography scans, lung ultrasonography (LUS) has been introduced in clinical practice to identify and differentiate neonatal lung diseases because of its radiation-free characteristic, convenience, high accuracy, and low cost. In recent years, it has been proved that LUS exhibits high sensitivity and specificity for identifying various neonatal lung diseases. Here, we offer an updated review of the applications of LUS in neonatal lung diseases based on the reports published in recent years (2017 to present).
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Affiliation(s)
- Jin Wang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hongjuan Wei
- Department of Neonatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hui Chen
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Ke Wan
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ruifeng Mao
- School of Life Sciences, Huaiyin Normal University, Huai'an, China
| | - Peng Xiao
- Department of Dermatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xin Chang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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19
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Lung Ultrasonography to Diagnose Bronchopulmonary Dysplasia of Premature Infants. IRANIAN JOURNAL OF PEDIATRICS 2021. [DOI: 10.5812/ijp.109598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background: Bronchopulmonary dysplasia (BPD) is a common severe respiratory problem in premature infants, and imaging information has important reference value for its diagnosis. Recently, lung ultrasonography (LUS) has been successfully used for the diagnosis and differential diagnosis of neonatal lung diseases (NLDs), but the study of the diagnosis of BPD is still rare. Objectives: The purpose of this study was to investigate the ultrasonographic characteristics of BPD and its value for the diagnosis and differential diagnosis of premature infants’ BPD. Methods: From January 2015 to December 2019, 25 premature infants diagnosed with early-stage BPD and 32 infants diagnosed with late-stage BPD according to their medical history, clinical manifestation, and chest X-ray were included in this study. The LUS examinations were performed on each infant. The LUS findings were recorded and compared with those of 40 premature infants without lung diseases. Results: The gestational age of 25 early-stage BPD infants was 26+1 – 31+6 weeks, and their birth weight was between 730 and 1,810 g. The gestational age of 32 late-stage BPD infants was 26 - 32 weeks, and their birth weight was 750 - 1,760 g. The gestational age of 40 control infants was 25+6 - 32+1 weeks, and their birth weight was 810 - 2,050 g. There was no difference in the proportion of primary lung diseases (including RDS, TTN, pneumonia, etc.) between the three groups. The proportions of infants receiving invasive and/or non-invasive respiratory support at admission in the three groups of early BPD, late BPD, and normal control were 20/25 (80.0%), 26/32 (81.2%), and 33/40 (77.5%), respectively, with no significant difference (P > 0.05). The mechanical ventilation duration over one week in three groups was 15/20 (75%), 21/26 (80.7%), and 24/33 (72.7%), respectively, with no significant difference (P > 0.05). Nonspecific pleural line abnormalities were seen in all early and late BPD patients (100%), alveolar-interstitial syndrome (AIS) in 16 cases (64%) of early BPD and 32 cases of late BPD infants (100%), pleural insect erosion-like change (PIE-like change) in two cases of early-stage BPD infants (8.0%) and 20 cases (62.5%) of late-stage BPD infants, and air vesicle signs (AVS) only in 17 cases of late-stage BPD infants. The sensitivity and specificity of PIE-like change for the diagnosis of late-stage BPD were 62.5% and 92.0%, respectively, and the sensitivity and specificity of AVS for the diagnosis of late-stage BPD were 53.1 and 100%, respectively. Conclusions: Lung ultrasonography is not specific for the diagnosis of early-stage BPD, but has a high reference value and specificity for the diagnosis of late-stage BPD when combined with obvious pulmonary fibrosis and pulmonary vesicle formation, which is mainly manifested by AIS, PIE-like change, and AVS.
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20
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Liu J, Qiu RX, Liu Y. Case Report: Neonatal Massive Pneumothorax Resulting in Compression Atelectasis Treated by Ultrasound-Guided Pleural Puncture Therapy: A Typical Case Based on Lung Ultrasound Finding. Front Pediatr 2021; 9:779615. [PMID: 34917564 PMCID: PMC8669828 DOI: 10.3389/fped.2021.779615] [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: 09/19/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Atelectasis is a complication of different pulmonary diseases; however, neonatal compression atelectasis due to pneumothorax is rarely reported in the literature. Recently, we encountered a typical case of atelectasis. A preterm infant was admitted to the neonatal intensive care unit owing to severe respiratory distress. Lung ultrasound examination confirmed severe pneumothorax and large area of atelectasis. Lung re-expansion occurred when the air was drained from the pleural cavity.
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21
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Martin JN, Tucker JM. Missing or making the timely diagnosis of acute fatty liver of pregnancy (AFLP): lessons learned. J Matern Fetal Neonatal Med 2020; 35:3595-3601. [PMID: 33032483 DOI: 10.1080/14767058.2020.1832075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To review the presenting signs, symptoms, laboratory findings, clinical courses, complications, and maternal outcomes in women determined on medicolegal review to have had acute fatty liver of pregnancy (AFLP). METHODS We retrospectively studied case files from women with medical and/or hypertensive complications of pregnancy which had been reviewed by the first author, deidentified and divested of legal documents so that only medical-related information was retained for later research and teaching purposes. Main outcomes are 12 lessons learned from this review to be offered for the future benefit of clinicians encountering patients with AFLP. RESULTS Eleven women with AFLP were identified within the 161 file database. Signs and symptoms present in 91-100% of women with AFLP were altered sensorium, a fast resting maternal pulse >100/min, gastrointestinal complaints, muscle pain and evidence of fetal compromise/stillbirth. Laboratory findings in 91-100% revealed abnormal liver, renal and coagulation tests, hyperuricemia, and very low serum glucose and albumin. A correct initial diagnosis of AFLP was made for only three women; the most common incorrect presumptive diagnosis was HELLP syndrome. Four women survived. Twelve major findings are discussed. CONCLUSION Rapid, timely and thorough evaluation of third trimester women presenting with A (Altered mental status changes/extreme sleepiness), F (Fast resting pulse >100 in the absence of fever or heart causation), L (Liver-related gastrointestinal complaints) and P (Pain as myalgias and body aches), often in association with evidence of fetal compromise or stillbirth, should initiate efforts to investigate a possible diagnosis of AFLP. Adoption of the concepts summarized including core initial laboratory testing, immediate patient transfer to tertiary care, and aggressive correction of consumptive coagulopathy could form the basis of a patient safety bundle to guide future management for patients with AFLP.
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Affiliation(s)
- James Nello Martin
- Obstetrics, Gynecology and Maternal-Fetal Medicine, The Winfred L. Wiser Hospital for Women and Infants, The University of Mississippi Medical Center, Jackson, MS, USA
| | - James Martin Tucker
- Obstetrics and Gynecology, The Winfred L. Wiser Hospital for Women and Infants, The University of Mississippi Medical Center, Jackson, MS, USA
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