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Maddaloni C, De Rose DU, Ronci S, Pugnaloni F, Martini L, Caoci S, Bersani I, Conforti A, Campi F, Lombardi R, Capolupo I, Tomà P, Dotta A, Calzolari F. The role of point-of-care ultrasound in the management of neonates with congenital diaphragmatic hernia. Pediatr Res 2024; 95:901-911. [PMID: 37978315 DOI: 10.1038/s41390-023-02889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
In the last few years, current evidence has supported the use of point-of-care ultrasound (POCUS) for a number of diagnostic and procedural applications. Considering the valuable information that POCUS can give, we propose a standardized protocol for the management of neonates with a congenital diaphragmatic hernia (CDH-POCUS protocol) in the neonatal intensive care unit. Indeed, POCUS could be a valid tool for the neonatologist through the evaluation of 1) cardiac function and pulmonary hypertension; 2) lung volumes, postoperative pleural effusion or pneumothorax; 3) splanchnic and renal perfusion, malrotations, and/or signs of necrotizing enterocolitis; 4) cerebral perfusion and eventual brain lesions that could contribute to neurodevelopmental impairment. In this article, we discuss the state-of-the-art in neonatal POCUS for which concerns congenital diaphragmatic hernia (CDH), and we provide suggestions to improve its use. IMPACT: This review shows how point-of-care ultrasound (POCUS) could be a valid tool for managing neonates with congenital diaphragmatic hernia (CDH) after birth. Our manuscript underscores the importance of standardized protocols in neonates with CDH. Beyond the well-known role of echocardiography, ultrasound of lungs, splanchnic organs, and brain can be useful. The use of POCUS should be encouraged to improve ventilation strategies, systemic perfusion, and enteral feeding, and to intercept any early signs related to future neurodevelopmental impairment.
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Affiliation(s)
- Chiara Maddaloni
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
- PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome "Tor Vergata", Rome, Italy.
| | - Sara Ronci
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Ludovica Martini
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Stefano Caoci
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Roberta Lombardi
- Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Flaminia Calzolari
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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Gregorio-Hernández R, Sánchez-Luna M. Reply to: Lung ultrasound in neonates with congenital diaphragmatic hernia and the need for a quantitative evaluation. Eur J Pediatr 2023; 182:5715-5716. [PMID: 37847264 DOI: 10.1007/s00431-023-05256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Affiliation(s)
- R Gregorio-Hernández
- Neonatology Department, Gregorio Marañón Hospital, O'Donnell 48 street, 28009, Madrid, Spain.
| | - M Sánchez-Luna
- Neonatology Department, Gregorio Marañón Hospital, O'Donnell 48 street, 28009, Madrid, Spain
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De Rose DU, Maddaloni C, Martini L, Ronci S, Capolupo I, Dotta A, Calzolari F. Lung ultrasound in neonates with congenital diaphragmatic hernia and the need for a quantitative evaluation. Eur J Pediatr 2023; 182:5713-5714. [PMID: 37721583 DOI: 10.1007/s00431-023-05198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Affiliation(s)
| | - Chiara Maddaloni
- Neonatal Intensive Care Unit - "Bambino Gesù", Children's Hospital IRCCS, 00165, Rome, Italy
| | - Ludovica Martini
- Neonatal Intensive Care Unit - "Bambino Gesù", Children's Hospital IRCCS, 00165, Rome, Italy
| | - Sara Ronci
- Neonatal Intensive Care Unit - "Bambino Gesù", Children's Hospital IRCCS, 00165, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit - "Bambino Gesù", Children's Hospital IRCCS, 00165, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit - "Bambino Gesù", Children's Hospital IRCCS, 00165, Rome, Italy
| | - Flaminia Calzolari
- Neonatal Intensive Care Unit - "Bambino Gesù", Children's Hospital IRCCS, 00165, Rome, Italy
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Gregorio-Hernández R, Ramos-Navarro C, Vigil-Vázquez S, Rodríguez-Corrales E, Pérez-Pérez A, Arriaga-Redondo M, Sánchez-Luna M. Lung ultrasound and postoperative follow-up of congenital diaphragmatic hernia. Eur J Pediatr 2023; 182:3973-3981. [PMID: 37368006 DOI: 10.1007/s00431-023-05074-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Lung ultrasound (LU) has emerged as a valuable tool for assessing pulmonary aeration noninvasively, rapidly, and reliably in different neonatal conditions. However, its role in the preoperative and postoperative evaluation in congenital diaphragmatic hernia (CDH) is still poorly analyzed. We present a cohort of 8 patients diagnosed with CDH who underwent lung ultrasound examinations at various time points before and after surgical correction. The lung ultrasound patterns were compared between two groups: mechanical ventilation ≤ 7 days (MV ≤ 7) and mechanical ventilation > 7 days (MV > 7). The ultrasound findings were also compared to CT scans and chest X-ray images to assess its diagnostic capacity for identifying postoperative complications: pneumothorax, pleural effusion, and pneumonia. Group MV ≤ 7 exhibited a normal pattern even at 48 h postsurgery, while group MV > 7 presented interstitial or alveolointerstitial pattern in both lungs for prolonged periods (2-3 weeks). Furthermore, contralateral LU pattern may be predictive of respiratory evolution. Conclusion: Lung ultrasound is a valuable tool for evaluating the progressive reaeration of the lung following surgical correction in CDH patients. It demonstrates the ability to diagnose common postoperative complications without the need for radiation exposure while offering the advantages of quick and serial assessments. These findings highlight the potential of lung ultrasound as an effective alternative to conventional imaging methods in the management of CDH. What is Known: • Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in neonatal patients. What is New: • Lung ultrasound is useful in the postsurgical management of congenital diaphragmatic hernia patients, detecting reaeration and respiratory complications.
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Affiliation(s)
| | - C Ramos-Navarro
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | - S Vigil-Vázquez
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - A Pérez-Pérez
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
| | | | - M Sánchez-Luna
- Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain
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