Mirrored Ribs: A Sign for Pneumothorax in Neonates

Management of Air Leaks in the Newborn

BACKGROUND

Air leaks, especially pulmonary interstitial emphysema (PIE), are increasingly uncommon respiratory complications of the newborn. Despite PIE having a decreasing incidence, it continues to have a high morbidity and mortality rate. This makes PIE one of the most severe respiratory complications to affect a newborn. Air leaks occur when there is overdistension of the terminal airways or alveoli, which results in air dissecting into extra-alveolar spaces. Recognizing the signs of air leaks is paramount to allow for appropriate diagnosis and treatment of the newborn to improve morbidity and mortality. Treatment modalities range from positioning the newborn in the decubitus position to surgical intervention.

PURPOSE

To summarize current evidence on the pathophysiology, risk factors, diagnosis, treatment, and management of PIE and pneumothorax.

DATA SOURCES

Two databases were systematically reviewed with key words later. Articles in English with date restrictions from 2016 to current were included.

STUDY SELECTION

Inclusion criteria of randomized controlled trials, case studies/reports, and review articles were utilized. Twenty articles, primarily case reports and studies, were reviewed.

DATA EXTRACTION

Guidelines for data abstraction were followed via independent extraction by a single observer.

RESULTS

Qualitative results were utilized to formulate current treatment of air leaks.

IMPLICATIONS FOR PRACTICE

This article provides guidance for frontline neonatal providers on current treatment and management of air leaks in the newborn population.

Ultrasound of pneumothorax in neonates: Diagnostic value of the anterior transverse plane and of mirrored ribs

INTRODUCTION

Point-of-care lung ultrasound is increasingly used to diagnose pneumothorax efficiently and safely in neonates.

OBJECTIVES

This study aimed to evaluate the usefulness of the central and anterior transverse thoracic plane in the ultrasound diagnosis of pneumothorax, analyze the diagnostic value of the "mirrored ribs" sign, and evaluate the predictive value of the lung point location for the need of pleural drainage.

METHODS

Retrospective cohort study of all newborns admitted to the neonatal intensive care unit of the Basurto University Hospital (Bilbao, Spain) due to respiratory distress and with ultrasound, with or without pneumothorax, between January 2014 and December 2020.

RESULTS

The presence of A-lines behind the sternum in the anterior transverse plane in newborns with pneumothorax (N = 311) and controls (N = 195) was compared. A-lines were present in 98.9% of newborns with pneumothorax compared to none in the controls (p < .0001). Diagnosis of pneumothorax with the anterior transverse plane presented high interobserver reproducibility (κ = 0.92, 95% confidence interval: 0.84-1.00). In contrast, the "mirrored ribs" sign in the anterior longitudinal plane was observed in 35.6% of patients with pneumothorax and in 36.9% of controls (p = .1505). A significant association was observed between lung point location and the need for pleural drainage (p < .0001).

CONCLUSIONS

A-lines in the anterior transverse plane is a simple ultrasound sign which presents high sensitivity, specificity, and reproducibility for the diagnosis of pneumothorax. The mirrored ribs sign showed low diagnostic utility. Patients with severe pneumothorax in lung ultrasound are most likely to require thoracic drainage.

Lung Ultrasonography for Pneumothorax in Dogs and Cats

A sonographic diagnosis of pneumothorax (PTX) traditionally relies on excluding the presence of lung sliding, lung pulse, and/or B lines/lung consolidations, and identifying the lung point. However, these criteria can be difficult to identify, particularly in critically ill patients with respiratory disorders, and the lung point is infrequently used. Newer sonographic findings, such as mirrored ribs, reverse lung sliding, and abnormal curtain signs, have been identified to try to increase the accuracy of diagnosing PTX. This article describes and discusses the lung ultrasonography criteria used to diagnose PTX in both human and small animal patients.

The Role of Lung Ultrasound in the Management of the Critically Ill Neonate-A Narrative Review and Practical Guide

Lung ultrasound makes use of artifacts generated by the ratio of air and fluid in the lung. Recently, an enormous increase of research regarding lung ultrasound emerged, especially in intensive care units. The use of lung ultrasound on the neonatal intensive care unit enables the clinician to gain knowledge about the respiratory condition of the patients, make quick decisions, and reduces exposure to ionizing radiation. In this narrative review, the possibilities of lung ultrasound for the stabilization and resuscitation of the neonate using the ABCDE algorithm will be discussed.