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Sartorius V, Brunet S, De Luca D. Characteristics of scores used for quantitative lung ultrasound in neonates: a systematic review. Eur Respir Rev 2025; 34:240232. [PMID: 40240059 PMCID: PMC12000906 DOI: 10.1183/16000617.0232-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 02/12/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Quantitative lung ultrasound is increasingly being used in neonatology. The aim of this study is to identify the lung ultrasound scores (LUS) available for use in neonates, describe their characteristics and determine which LUS are most used and validated. METHODS A systematic review of the literature was conducted following PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for reporting literature searches in systematic reviews) guidelines. Articles describing LUS in newborn animals and human neonates, published up to March 2024, were searched in the PubMed and Embase databases. RESULTS Out of 757 identified studies, 121 were included. Most of the articles were published in the past 5 years, predominantly by European investigators. They described 32 different LUS. Only 10 (31.4%) of these LUS had undergone at least one validation attempt and only 15 (48.4%) used the four-step scoring scale (i.e. scored from 0 to 3) based on classical lung ultrasound patterns originally described and well established in adult critical care medicine. The most common (49 (40.5%) of all the articles) neonatal score (published by Brat et al. in 2015) was based on this classical grading system. The most commonly used score was also validated using the greatest number of techniques and applied to all major neonatal respiratory disorders. Its simplified version is used to analyse six chest areas (anterior and lateral) to guide surfactant administration, while its extended version includes 10 areas by adding four posterior ones. CONCLUSIONS The most commonly used and validated score, consistent with adult critical care practice, should be the standard for assessing lung aeration in neonates.
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Affiliation(s)
- Victor Sartorius
- Department of Neonatal Intensive Care, Hôpital Necker Enfants-Malades, Université Paris-Cité, APHP, Paris, France
| | - Stéphanie Brunet
- Department of Neonatal Intensive Care, Hôpital Necker Enfants-Malades, Université Paris-Cité, APHP, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
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Popa AE, Popescu SD, Tecuci A, Bot M, Vladareanu S. Current Trends in the Imaging Diagnosis of Neonatal Respiratory Distress Syndrome (NRDS): Chest X-ray Versus Lung Ultrasound. Cureus 2024; 16:e69787. [PMID: 39429372 PMCID: PMC11490972 DOI: 10.7759/cureus.69787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 10/22/2024] Open
Abstract
Neonatal respiratory distress syndrome (NRDS) is a major cause of morbidity and mortality in newborns, particularly in neonatal intensive care units (NICUs). Until recently, its diagnosis had been based on clinical signs, arterial blood gas analysis, and chest X-ray (CXR). However, the frequent use of CXR exposes newborns to ionizing radiation, which can have long-term negative effects, including an increased risk of cancer, especially among premature infants. Lung ultrasound (LUS) has been proposed as a promising alternative for diagnosing NRDS due to its many advantages: no exposure to radiation, the ability to be performed at the bedside, repeatability, and ease of use. This review compared the diagnostic accuracy of LUS with the reference standard, CXR, in evaluating NRDS in newborns admitted to the NICU. Studies have shown that LUS can identify specific signs of NRDS, such as bilateral "white lung," pleural line abnormalities, and lung consolidations. The method has high sensitivity and specificity for diagnosing this condition and offers several advantages over other diagnostic methods; it does not involve ionizing radiation, thereby eliminating the risk of radiation exposure; it is cost-effective, easy to use, and can be performed at the patient's bedside, making it a viable alternative to CXR for reducing ionizing radiation exposure. Additionally, LUS can be used to monitor the progression of respiratory diseases and guide clinical management, especially in determining the optimal timing for surfactant administration in newborns with respiratory distress syndrome (RDS). We conclude that LUS is an effective and non-invasive alternative method for diagnosing and managing NRDS, with the potential to improve the safety and quality of care in the NICU, where rapid and safe diagnostic tools are essential for managing the health of newborns.
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Affiliation(s)
- Alexandra E Popa
- Obstetrics and Gynaecology and Neonatology, Elias Emergency University Hospital, Bucharest, ROU
- Obstetrics and Gynaecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Simona D Popescu
- Obstetrics and Gynaecology and Neonatology, Elias Emergency University Hospital, Bucharest, ROU
- Obstetrics and Gynaecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Adriana Tecuci
- Obstetrics and Gynaecology and Neonatology, Elias Emergency University Hospital, Bucharest, ROU
- Obstetrics and Gynaecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Mihaela Bot
- Obstetrics and Gynaecology, Elias Emergency University Hospital, Bucharest, ROU
- Obstetrics and Gynaecology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Simona Vladareanu
- Obstetrics and Gynaecology and Neonatology, Elias Emergency University Hospital, Bucharest, ROU
- Obstetrics and Gynaecology and Neonatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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Bao LY, Dao XY, Du K. Progress in the Application of Lung Ultrasound for the Evaluation of Neonates with Respiratory Distress Syndrome. J Multidiscip Healthc 2024; 17:1-9. [PMID: 38192739 PMCID: PMC10771789 DOI: 10.2147/jmdh.s442464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 01/10/2024] Open
Abstract
Neonatal respiratory distress syndrome (NRDS) is a common critical disease in neonates. Early diagnosis and timely treatment are crucial. Historically, X-ray imaging was the primary method for diagnosing NRDS. However, this method carries radiation exposure risks, making it unsuitable for dynamic lung condition monitoring. In addition, neonates who are critically ill require bedside imaging, but diagnostic delays are often unavoidable due to equipment transportation and positioning limitations. These challenges have been resolved with the introduction of lung ultrasound (LUS) in neonatal intensive care. The diagnostic efficacy and specificity of LUS for NRDS is superior to that of X-ray. The non-invasive, dynamic, and real-time benefits of LUS also allow for real-time monitoring of lung changes throughout treatment for NRDS, yielding important insights for guiding therapy. In this paper, we examine the ultrasonographic characteristics of NRDS and the recent progress in the application of ultrasound in the diagnosis and treatment of NRDS while aiming to promote wider adoption of this method.
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Affiliation(s)
- Ling-Yun Bao
- Department of Neonate, Kun Ming Children’s Hospital, Yunnan, 650021, People’s Republic of China
| | - Xin-Yue Dao
- Department of Neonate, Kun Ming Children’s Hospital, Yunnan, 650021, People’s Republic of China
| | - Kun Du
- Department of Neonate, Kun Ming Children’s Hospital, Yunnan, 650021, People’s Republic of China
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Bediwy AS, Al-Biltagi M, Nazeer JA, Saeed NK. Chest ultrasound in neonates: What neonatologists should know. Artif Intell Med Imaging 2022; 3:8-20. [DOI: 10.35711/aimi.v3.i1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Affiliation(s)
- Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Mohammed Al-Biltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Jameel Ahmed Nazeer
- Department of Radiology, University Medical center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex , Ministry of Health, Kingdom of Bahrain , Manama 12, Manama, Bahrain
- Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
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Liu X, Si S, Guo Y, Wu H. Limitations of Bedside Lung Ultrasound in Neonatal Lung Diseases. Front Pediatr 2022; 10:855958. [PMID: 35558371 PMCID: PMC9086677 DOI: 10.3389/fped.2022.855958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Lung ultrasound is a technique that has rapidly developed in recent years. It is a low-cost, radiation-free, and easy-to-operate tool that can be repeatedly performed at the bedside. Compared to chest X-ray, lung ultrasound has high sensitivity and specificity in the diagnosis of neonatal respiratory distress syndrome, transient tachypnoea of newborns and pneumothorax. Lung ultrasound has been widely used in neonatal intensive care units. However, due to the physical barriers of air, where ultrasonic waves cannot pass and therefore reflection artifacts occur, it has limitations in some other lung diseases and cannot fully substitute for chest X-rays or CT/MRI scanning. This review describes these limitations in detail and highlights that if clinical symptoms are not effectively alleviated after medical treatment or the clinical presentation is not compatible with the ultrasound appearances, then chest X-rays or CT/MRI scanning should be performed to avoid misdiagnosis and mistreatment.
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Affiliation(s)
- Xiaolei Liu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Shuyu Si
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Yiyi Guo
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
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Ammirabile A, Buonsenso D, Di Mauro A. Lung Ultrasound in Pediatrics and Neonatology: An Update. Healthcare (Basel) 2021; 9:1015. [PMID: 34442152 PMCID: PMC8391473 DOI: 10.3390/healthcare9081015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/24/2022] Open
Abstract
The potential role of ultrasound for the diagnosis of pulmonary diseases is a recent field of research, because, traditionally, lungs have been considered unsuitable for ultrasonography for the high presence of air and thoracic cage that prevent a clear evaluation of the organ. The peculiar anatomy of the pediatric chest favors the use of lung ultrasound (LUS) for the diagnosis of respiratory conditions through the interpretation of artefacts generated at the pleural surface, correlating them to disease-specific patterns. Recent studies demonstrate that LUS can be a valid alternative to chest X-rays for the diagnosis of pulmonary diseases, especially in children to avoid excessive exposure to ionizing radiations. This review focuses on the description of normal and abnormal findings during LUS of the most common pediatric pathologies. Current literature demonstrates usefulness of LUS that may become a fundamental tool for the whole spectrum of lung pathologies to guide both diagnostic and therapeutic decisions.
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Affiliation(s)
- Angela Ammirabile
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Science and Human Oncology, “Aldo Moro” University of Bari, 70100 Bari, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Via Conversa 12, 10135 Margherita di Savoia, Italy;
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Abstract
Supplemental digital content is available in the text. Chest radiography is the primary imaging modality used for the assessment of neonatal respiratory distress syndrome (NRDS) in newborns. However, excessively exposing a growing neonate to harmful ionizing radiation may have long-term consequences. Some studies have shown that lung ultrasound (LUS) is helpful in the diagnosis of NRDS. A comprehensive search was carried out using PubMed, Embase, and the Cochrane Library to identify studies in which newborns with clinically suspected NRDS were assessed by LUS. Two investigators independently screened the literature and extracted the data. Any discrepancies were resolved via discussion with the senior author. Study quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various LUS findings for diagnosing NRDS were determined. Summary receiver operating characteristic curve was used to assess the overall performance of LUS. Ten studies with a total of 887 neonates were included in this meta-analysis. There was significant heterogeneity across the included studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for the diagnosis of NRDS using LUS were 0.92 (95% confidence interval [CI], 0.89–0.94), 0.95 (95% CI, 0.93–0.97), 20.23 (95% CI, 8.54–47.92), 0.07 (95% CI, 0.03–0.14), and 455.30 (95% CI, 153.01–1354.79), respectively. Furthermore, the summary receiver operating characteristic area under the curve was calculated to be 0.9888. The main LUS characteristics of NRDS include bilateral white lung, pleural line abnormalities, and lung consolidation. In summary, LUS is a highly valuable diagnostic technology that complements chest radiography in the diagnosis and follow-up monitoring of NRDS.
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8
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Corsini I, Parri N, Ficial B, Dani C. Lung ultrasound in the neonatal intensive care unit: Review of the literature and future perspectives. Pediatr Pulmonol 2020; 55:1550-1562. [PMID: 32339409 DOI: 10.1002/ppul.24792] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/30/2023]
Abstract
Lung ultrasound (LU) has been increasingly used as a point-of-care method in recent years. LU has numerous advantages compared to traditional imaging tools such as chest X-ray (radiography) (CXR): it is faster and portable, does not use ionizing radiation, is performed by the same physician who cares for the patient, and can be repeated to follow the progress of the disease and the response to treatment. There is a large body of evidence that LU has an excellent diagnostic effectiveness compared to CXR, not only in adults and children, but also in neonates. This review article describes how to perform LU, how to interpret findings, and how to use LU to diagnose and differentiate common neonatal pulmonary diseases. Strengths but also limits of the technique are highlighted. Finally, we describe the recent revolutionary role of LU. The development of scoring methods in neonates with respiratory distress syndrome allowed to quantify the severity of the disease and to assist the physician in the clinical management and follow-up.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Niccolò Parri
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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9
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Lovrenski J. Pediatric lung ultrasound - pros and potentials. Pediatr Radiol 2020; 50:306-313. [PMID: 32065266 DOI: 10.1007/s00247-019-04525-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/12/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
Abstract
Lung ultrasound (US) cannot be considered a new diagnostic imaging technique anymore, with some articles dating back 50 years. The question that hovers over it recently is why it is still not widely accepted, like chest radiography. So, have we wasted a lot of time without using lung US, or are we wasting our time using lung US? The main goals of this article are to underline all the advantages, potentials and reasons to use lung US in everyday clinical practice, but also to address the main concerns linked to this imaging tool. From the standpoint of an experienced pediatric radiologist from a tertiary health care children's hospital who has been performing this examination for more than 10 years on a daily basis, this article also addresses the most common applications of lung US, such as detection of pneumonia and neonatal lung diseases.
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Affiliation(s)
- Jovan Lovrenski
- Radiology Department, Faculty of Medicine, University of Novi Sad and Institute for Children and Adolescents Health Care of Vojvodina, Hajduk Veljkova 3, Novi Sad, 21000, Serbia.
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10
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Tomà P. Lung ultrasound in pediatric radiology - cons. Pediatr Radiol 2020; 50:314-320. [PMID: 32065267 DOI: 10.1007/s00247-019-04524-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/25/2019] [Accepted: 09/02/2019] [Indexed: 01/04/2023]
Abstract
In the 1990s, intensivists suggested a new type of sonography: lung ultrasound, based on artefacts that receive information even from physical acoustic phenomena not directly convertible into images of the human body. They compared the artefacts from the lung zones with no acoustic window with various computed tomography (CT) patterns. They used and still use US as a tool to evaluate patients bedside, i.e. monitoring of lung recruitment. They included Lung ultrasound in what was termed POCUS (Point-of-Care Ultrasound). Lung ultrasound has been progressively extended to paediatrics in general. The most appealing novelty has been the diagnosis of pneumothorax. Lung ultrasound was developed as a support tool for critical patients. Extrapolation with mass diffusion, in the absence of appropriate training, has led to misunderstandings and dangerous therapeutic diagnostic drifts.
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Affiliation(s)
- Paolo Tomà
- Ospedale pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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11
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Riccabona M, Laffan E. Chest and lung ultrasound in childhood: applications, role, value and limitations. J Ultrason 2019; 18:281-283. [PMID: 30763010 PMCID: PMC6444311 DOI: 10.15557/jou.2018.0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, Medical University of Graz , Graz , Austria
| | - Eoghan Laffan
- Department of Radiology, Children's University Hospital Dublin , Dublin , Ireland
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12
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Kurepa D, Zaghloul N, Watkins L, Liu J. Neonatal lung ultrasound exam guidelines. J Perinatol 2018; 38:11-22. [PMID: 29144490 DOI: 10.1038/jp.2017.140] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 06/13/2017] [Accepted: 08/09/2017] [Indexed: 02/08/2023]
Abstract
Point-of-care ultrasound (POC-US) is increasingly used especially in emergency and critical-care medicine. It is focused, quick and does not expose patients to ionizing radiation. It encompasses all organ systems and has well-defined indications. Lung ultrasound (LUS) represents one of the most exciting applications in the field of POC-US. It is particularly important to emphasize the role of LUS in neonatology due to the specific pathology inherent in lung immaturity as well as in the particular sensitivity of neonates to repeated radiation exposure. One of the main barriers to the more extensive use of the ultrasound technology is a lack of efficient and attractive training solutions followed by the structured quality-check assurance. In an effort to help bridge this gap, based on the most current literature, we developed creative and intuitive neonatal LUS algorithms. We hope they can serve as a clinical imaging guidelines and a valuable complement to the history and physical exam.
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Affiliation(s)
- D Kurepa
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - N Zaghloul
- Division of Neonatal-Perinatal Medicine, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - L Watkins
- Division of Pediatric Critical Care, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - J Liu
- Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, China
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Liszewski MC, Stanescu AL, Phillips GS, Lee EY. Respiratory Distress in Neonates. Radiol Clin North Am 2017; 55:629-644. [DOI: 10.1016/j.rcl.2017.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hiles M, Culpan AM, Watts C, Munyombwe T, Wolstenhulme S. Neonatal respiratory distress syndrome: Chest X-ray or lung ultrasound? A systematic review. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2017; 25:80-91. [PMID: 28567102 DOI: 10.1177/1742271x16689374] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 12/25/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Neonatal respiratory distress syndrome is a leading cause of morbidity in preterm new-born babies (<37 weeks gestation age). The current diagnostic reference standard includes clinical testing and chest radiography with associated exposure to ionising radiation. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against the reference standard in symptomatic neonates of ≤42 weeks gestation age. METHODS A systematic search of literature published between 1990 and 2016 identified 803 potentially relevant studies. Six studies met the review inclusion criteria and were retrieved for analysis. Quality assessment was performed before data extraction and meta-analysis. RESULTS Four prospective cohort studies and two case control studies included 480 neonates. All studies were of moderate methodological quality although heterogeneity was evident across the studies. The pooled sensitivity and specificity of lung ultrasound were 97% (95% confidence interval [CI] 94-99%) and 91% (CI: 86-95%) respectively. False positive diagnoses were made in 16 cases due to pneumonia (n = 8), transient tachypnoea (n = 3), pneumothorax (n = 1) and meconium aspiration syndrome (n = 1); the diagnoses of the remaining three false positive results were not specified. False negatives diagnoses occurred in nine cases, only two were specified as air-leak syndromes. CONCLUSIONS Lung ultrasound was highly sensitive for the detection of neonatal respiratory distress syndrome although there is potential to miss co-morbid air-leak syndromes. Further research into lung ultrasound diagnostic accuracy for neonatal air-leak syndrome and economic modelling for service integration is required before lung ultrasound can replace chest radiography as the imaging component of the reference standard.
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Affiliation(s)
- Matthew Hiles
- Department of Radiology, Hull and East Yorkshire NHS Trust, Ultrasound Department, UK.,Division of Biomedical Imaging, Faculty of Medicine & Health, University of Leeds, UK
| | - Anne-Marie Culpan
- Division of Biomedical Imaging, Faculty of Medicine & Health, University of Leeds, UK
| | - Catriona Watts
- Department of Radiology, Hull and East Yorkshire NHS Trust, Ultrasound Department, UK
| | - Theresa Munyombwe
- Division of Epidemiology and Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
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15
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El-Malah HEDGM, Hany S, Mahmoud MK, Ali AM. Lung ultrasonography in evaluation of neonatal respiratory distress syndrome. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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16
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Potential of ultrasound in the pediatric chest. Eur J Radiol 2014; 83:1507-18. [DOI: 10.1016/j.ejrad.2014.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
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17
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Vergine M, Copetti R, Brusa G, Cattarossi L. Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology 2014; 106:87-93. [PMID: 24819542 DOI: 10.1159/000358227] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is a promising technique for the diagnosis of neonatal respiratory diseases. Preliminary data has shown a good sensitivity and specificity of LUS in the diagnosis of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). OBJECTIVE The aim of this study was to calculate the sensitivity, specificity, and negative (NPV) and positive predictive value (PPV) of LUS for RDS and TTN, using an external reader blinded to the clinical condition. DESIGN AND METHODS Neonates with respiratory distress had a LUS within 1 h of admission. Images were uploaded and sent to the external reader, who made the ultrasound diagnosis according to the appearance of the images. The final clinical diagnosis was made according to all the available data, except LUS data. Sensitivity, specificity, PPV, and NPV were calculated considering the final clinical diagnosis as the gold standard. RESULTS Fifty-nine neonates were studied (mean gestational age: 33 ± 4 weeks, mean birth weight: 2,145 ± 757 g). Twenty-three infants had a final diagnosis of RDS and 30 of TTN. LUS showed a sensitivity of 95.6% and specificity of 94.4%, with a PPV of 91.6% and a NPV of 97.1% for RDS, and a sensitivity of 93.3% and specificity of 96.5% with a PPV of 96.5% and a NPV of 93.4% for TTN. CONCLUSIONS LUS showed high sensitivity and specificity in diagnosing RDS and TTN.
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Affiliation(s)
- Michela Vergine
- Department of Pediatrics, Azienda Ospedaliero Universitaria 'S. Maria della Misericordia', Udine, Italy
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18
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Chest ultrasound in children: critical appraisal. Pediatr Radiol 2013; 43:1427-34; quiz 1425-6. [PMID: 24141909 DOI: 10.1007/s00247-013-2756-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/27/2013] [Accepted: 06/01/2013] [Indexed: 02/07/2023]
Abstract
We analyze the potential use of ultrasound in the study of the thorax in children. The physical limitations imposed on sonography by the ventilated lung and thoracic cage are well known. We want to discuss new US applications based on the clinical and methodological experience gained in adults as outlined by emergency and critical care specialists. These specialists take information from physical acoustic phenomena that is not directly convertible into images of the human body, starting with the interpretation and handling of artifacts. We give a critical assessment from a radiologic viewpoint that is both necessary and important.
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Ahuja CK, Saxena AK, Sodhi KS, Kumar P, Khandelwal N. Role of transabdominal ultrasound of lung bases and follow-up in premature neonates with respiratory distress soon after birth. Indian J Radiol Imaging 2013; 22:279-83. [PMID: 23833419 PMCID: PMC3698890 DOI: 10.4103/0971-3026.111480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Chest radiography has been the traditional method of diagnostic evaluation of patients of hyaline membrane disease (HMD). Lung sonography (USG) has been lately explored as an alternative modality. Aims: To explore the application of transabdominal USG of lung bases (TASL) in the evaluation of HMD in premature neonates with respiratory distress soon after birth. Settings and Design: Tertiary care institutional setup. Study duration–18 months. Follow-up–variable, up to 1 month. Prospective descriptive study. Materials and Methods: Eighty-eight consecutive patients admitted in the neonatal intensive care unit (NICU) with gestational age <32 weeks having respiratory distress within 6 h of birth were enrolled. The diagnosis of HMD was made if the patient had negative gastric shake test and/or suggestive chest radiograph. TASL was performed in all patients within the first 24 h of life and biweekly subsequently. USG was interpreted as normal, HMD pattern, or broncho-pulmonary dysplasia (BPD) pattern. Biweekly follow-up was done for patients showing HMD till normalization of the sonographic HMD pattern, development of the sonographic BPD pattern, or death/discharge of the neonate from the hospital. Results and Conclusions: TASL showed 85.7% sensitivity, 75% specificity, 88.88% positive predictive value, and 69.2% negative predictive value for the diagnosis of HMD. The abnormal sonographic findings on day 14 had 94.1% accuracy for prediction of eventual occurrence of clinical BPD. TASL is complementary to chest radiograph in the diagnosis of HMD. It is also useful for the early prediction of BPD with the potential of reducing the cumulative radiation dose to these neonates.
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Affiliation(s)
- Chirag Kamal Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
AIM To evaluate the diagnostic possibilities of lung ultrasonography (LUS) in detecting pulmonary complications in preterm infants with respiratory distress syndrome (RDS). MATERIAL AND METHODS A prospective study included 120 preterm infants with clinical and radiographic signs of RDS. LUS was performed using both a transthoracic and a transabdominal approach within the first 24 h of life, and, after that, follow-up LUS examinations were performed. In 47 detected pulmonary complications of RDS (hemorrhage, pneumothorax, pneumonia, atelectasis, bronchopulmonary dysplasia), comparisons between LUS and chest X-ray (CXR) were made. Also, 90 subpleural consolidations registered during LUS examinations were analysed. Statistical analysis included MANOVA and discriminant analysis, t-test, confidence interval, and positive predictive value. RESULTS In 45 of 47 instances the same diagnosis of complication was detected with LUS as with CXR, indicating a high reliability of the method in premature infants with RDS. The only two false negative findings concerned partial pneumothorax. The positive predictive value of LUS was 100%. A statistically significant difference of LUS findings between the anterior and posterior lung areas was observed in both right and left hemithoraces. CONCLUSIONS LUS enables the detection of pulmonary complications in preterm infants with RDS and has the potential to reduce the number of CXRs. The specific guidelines for its use should be provided in a more extensive study.
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Affiliation(s)
- Jovan Lovrenski
- Department, Institute for Children and Adolescents Health Care of Vojvodina, Gogoljeva, Novi Sad, Serbia.
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Coley BD. Chest Sonography in Children: Current Indications, Techniques, and Imaging Findings. Radiol Clin North Am 2011; 49:825-46. [DOI: 10.1016/j.rcl.2011.06.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sartori S, Tombesi P. Emerging roles for transthoracic ultrasonography in pulmonary diseases. World J Radiol 2010; 2:203-214. [PMID: 21160632 PMCID: PMC2999323 DOI: 10.4329/wjr.v2.i6.203] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 05/21/2010] [Accepted: 05/28/2010] [Indexed: 02/06/2023] Open
Abstract
As a result of many advantages such as the absence of radiation exposure, non-invasiveness, low cost, safety, and ready availability, transthoracic ultrasonography (TUS) represents an emerging and useful technique in the management of pleural and pulmonary diseases. In this second part of a comprehensive review that deals with the role of TUS in pleuropulmonary pathology, the normal findings, sonographic artifacts and morphology of the most important and frequent pulmonary diseases are described. In particular, the usefulness of TUS in diagnosing or raising suspicion of pneumonia, pulmonary embolism, atelectasis, diffuse parenchymal diseases, adult and newborn respiratory distress syndrome, lung cancer and lung metastases are discussed, as well as its role in guidance for diagnostic and therapeutic interventional procedures. Moreover, the preliminary data about the role of contrast enhanced ultrasonography in the study of pulmonary pleural-based lesions are also reported. Finally, the limits of TUS when compared with chest computed tomography are described, highlighting the inability of TUS to depict lesions that are not in contact with the pleura or are located under bony structures, poor visualization of the mediastinum, and the need for very experienced examiners to obtain reliable results.
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Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology 2008; 94:52-9. [PMID: 18196931 DOI: 10.1159/000113059] [Citation(s) in RCA: 194] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 11/08/2007] [Indexed: 01/26/2023]
Abstract
BACKGROUND Respiratory distress syndrome (RDS) is a severe form of neonatal respiratory distress which occurs almost exclusively in premature infants. At present, the diagnosis is based on radiological findings and clinical course. Lung ultrasound in RDS has not yet been fully assessed. OBJECTIVES The aim of the study was to define the ultrasonographic appearance of RDS and evaluate its clinical relevance. METHODS Lung sonography was performed in 40 newborn infants with radiological and clinical signs of RDS (mean gestational age 27.2 +/- 2.7 weeks, mean birth weight 1,057 +/- 361 g) and in 15 preterm infants without RDS (mean gestational age 30.4 +/- 3.4 weeks, mean birth weight 1,775 +/- 669 g). RESULTS In all the studied infants with RDS, lung ultrasound consistently showed generalized alveolar-interstitial syndrome (echographic 'white lung'), pleural line abnormalities (small subpleural consolidations, thickening, irregularity and coarse appearance) and an absence of areas with a normal pattern ('spared areas'). When presented simultaneously, these signs identify RDS with a sensitivity and specificity of 100%. CONCLUSIONS We found that lung ultrasound is a reliable tool in the diagnosis of RDS. We speculate that it may be considered as a screening method for the diagnosis of RDS, and for early administration of surfactant in preterm infants with respiratory distress.
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Affiliation(s)
- Roberto Copetti
- Emergency and Pediatric Departments, S. Antonio Abate Hospital, Tolmezzo, Italy.
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Riccabona M. Ultrasound of the chest in children (mediastinum excluded). Eur Radiol 2007; 18:390-9. [PMID: 17952440 DOI: 10.1007/s00330-007-0754-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Revised: 06/13/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
Abstract
Ultrasound (US) of the paediatric chest has become an established imaging tool that may supplement plain film findings helping to reduce or tailor other ionizing (sectional) imaging in a variety of paediatric conditions such as sequestration or pneumonia. US has been shown to offer valuable imaging alternatives, both reliably enabling diagnosis without need for ionising imaging such as in diaphragmatic palsy (traditionally diagnosed by fluoroscopy) and revealing additional information in patients with equivocal findings on radiographs or replacing follow-up examinations (for example, in pleural effusion). This review outlines the technical requisites for paediatric chest US applications and will discuss its diagnostic potential. Furthermore, it will consider US restrictions, mention some rare applications, and discuss the potential role of chest US in imaging algorithms of certain conditions.
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Affiliation(s)
- Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
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Copetti R, Cattarossi L. The 'double lung point': an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology 2007; 91:203-9. [PMID: 17377407 DOI: 10.1159/000097454] [Citation(s) in RCA: 155] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 09/12/2006] [Indexed: 01/15/2023]
Abstract
BACKGROUND Transient tachypnea of the newborn (TTN) is a mild form of neonatal respiratory distress which early in its course needs to be differentiated from other severe respiratory disorders. At present the diagnosis is based on radiological findings and clinical course. Lung sonography in TTN has not yet been assessed. OBJECTIVES The aim of the study was to define the ultrasonographic appearance of TTN and evaluate its clinical relevance. METHODS Lung sonography was performed in 32 newborn infants with radiological and clinical signs of TTN within the first hour after birth and the findings were compared with those of 60 normal infants, 29 with respiratory distress syndrome, 6 with pneumonia, 5 with pulmonary hemorrhage and 5 with atelectasis. RESULTS In the infants with TTN, lung sonography showed a difference in lung echogenicity between the upper and lower lung areas. There were very compact comet-tail artifacts in the inferior fields while these were rare in the superior fields. We designated this finding the 'double lung point' and it was not observed in healthy infants, infants with respiratory distress syndrome, actelectasis, pneumothorax, pneumonia, or pulmonary hemorrhage. Sensitivity and specificity of the double lung point was 100% for the diagnosis of TTN. CONCLUSION We found lung sonography reliable for the early diagnosis of TTN. We suggest that it should become the first approach for imaging of neonatal respiratory distress although further prospective studies with good blinding need to be performed.
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Affiliation(s)
- Roberto Copetti
- Department of Emergency, S. Antonio Abate Hospital, Tolmezzo, Italy.
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Carlo WA, Bancalari E. Can lung ultrasound scanning be a useful diagnostic tool in neonates with respiratory distress? Neonatology 2007; 91:210-1. [PMID: 17377408 DOI: 10.1159/000097455] [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: 05/30/2006] [Accepted: 09/12/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama 35233-7335, USA.
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Abstract
Ultrasound examination of the thorax can be quite rewarding in children, because their unique thoracic anatomy provides many acoustic windows into the chest. With only a modest effort, chest ultrasonography can provide many clinically relevant answers, without the radiation exposure from CT, or the need for sedation sometimes required for CT and MR imaging.
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Affiliation(s)
- Brian D Coley
- Section of Ultrasound, Department of Radiology, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
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28
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Abstract
Thoracic sonography has become an established imaging tool for evaluating specific paediatric thoracic diseases; particularly queries such as thymomegaly, pleural effusion, pulmonal sequester or thoracic small part pathology may be reliably addressed. Using appropriate ultrasound equipment the well trained and experienced investigator may diagnose these conditions without the need for a radiating imaging modality or help to evaluate equivocal findings on chest plain films. The important requisites as well as the established disease entities that pose an indication for thoracic ultrasound are listed and described. The restrictions and setbacks are discussed, and an algorithm for additional imaging and typical scenarios is supposed in order to help and encourage the meaningful and efficient use of this non-ionising, easy applicable imaging tool to chest queries. In conclusion, this review tries to give an overview of the restrictions and indications for thoracic sonography in neonates, infants and children as a useful imaging tool when indicated.
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Affiliation(s)
- M Riccabona
- Abt. für Kinderradiologie, Univ.-Klinik für Radiologie Graz, Austria.
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Jung C, Bostedt H. Thoracic Ultrasonography Technique in Newborn Calves and Description of Normal and Pathological Findings. Vet Radiol Ultrasound 2004; 45:331-5. [PMID: 15373260 DOI: 10.1111/j.1740-8261.2004.04063.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to establish whether thoracic ultrasonography is a viable screening method for detecting respiratory disorders in newborn calves. Thoracic ultrasonography was performed on 66 newborn calves. There were 10 normal control animals with healthy lungs and 56 newborn calves suffering from respiratory disorders such as lung atelectasis, aspiration of amniotic fluid, pulmonary edema, pneumonia, and lung abscesses. Ultrasonography of the lung enabled rapid classification of the severity, extent and type of pulmonary lesion found, thus supplementing the clinical examination. Processes deep to the pleura were not amenable to thoracic diagnosis by ultrasonography. This is due to the inability of sound waves to penetrate normally ventilated lung. Despite this problem, ultrasonography of the lung is suitable for assessment of clinically unclear respiratory disorders in calves.
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Affiliation(s)
- C Jung
- Clinic for obstetrics, Gynaecology and Andrology of Large and Small Animals with an Ambulatory Service of the Justus-Liebig-University, Frankfurter Str 106, 35392 Giessen, Germany.
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Pieper CH, Smith J, Brand EJ. The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia. Pediatr Radiol 2004; 34:227-31. [PMID: 14685792 DOI: 10.1007/s00247-003-1102-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2002] [Revised: 08/22/2003] [Accepted: 10/06/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is one of the most serious complications of neonatal mechanical ventilation. Early diagnosis may influence treatment options such as early steroid administration. OBJECTIVE To assess the role of US of the lungs in predicting the development of BPD in infants with hyaline membrane disease (HMD) and to determine the earliest possible age at which the diagnosis of BPD could be made with certainty. PATIENTS AND METHODS Consecutive premature newborn infants requiring assisted ventilation during 1997-1998 who were admitted because of HMD were studied prospectively. US of the lungs was performed within 3 days of birth and three times a week thereafter until discharge from the neonatal intensive care unit. Each patient was also clinically and radiographically evaluated for the presence or absence of BPD at day 28 of life. Lung US scans were correlated with the development of BPD. RESULTS Retrodiaphragmatic hyperechogenicity (RH) was initially observed in 28 of the 36 patients with HMD, but resolved completely in 24 (96%) of 25 infants who had an uncomplicated clinical course. In eight of the ten infants who developed BPD, RH persisted. Day 9 was the earliest day where persistence of abnormal RH was observed with the highest predictor values for the development of BPD. CONCLUSIONS Lung US is a valuable technique for predicting the development of BPD.
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Affiliation(s)
- Clarissa H Pieper
- Neonatal Division, Department of Paediatrics and Child Health, Tygerberg Hospital, P.O. Box 19063, 7505 Tygerberg, South Africa.
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Kohzaki S, Tsurusaki K, Uetani M, Nakanishi K, Hayashi K. The aurora sign: an ultrasonographic sign suggesting parenchymal lung disease. Br J Radiol 2003; 76:437-43. [PMID: 12857701 DOI: 10.1259/bjr/16438547] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The objective of this study was to clarify the cause and clinical significance of a large number of ring-down artefact (RA) observed on the dorsal side of the right hepatic lobe on abdominal ultrasound (US). 2000 abdominal US examinations were evaluated to investigate the frequency and number of RA behind the right lobe of the liver. In this study, RA observed by subcostal or intercostal US were described as the "aurora sign" when they were numerous. US findings were correlated with high resolution CT or three-dimensional CT of the right lung base. Experimental study was also performed to investigate the mechanism of the aurora sign. The results were as follows. (1). Aurora sign was noted in 43 patients. In 37 of these 43 patients (86.0%), chest CT or plain radiography revealed diffuse interstitial changes in the right lower lung field. Three-dimensional CT of the lung and the experimental model revealed that the aurora sign derived from the irregularity of air spaces immediately below the pleura associated with interstitial pulmonary disorders. (2). One or more bands of RA were observed in 907 of the 2000 patients (45.4%). Of 177 patients with fatty liver, RA was observed in 14 (7.9%), while of the 1823 patients with no fatty liver, RA was observed in 893 (49.0%). The frequency of RA was significantly different (p<0.001) between the patients with and without fatty liver. In conclusion, parenchymal lung disease should be suspected when the aurora sign is noted on the dorsal side of the right hepatic lobe. However, RAs are rare in patients with fatty liver.
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Affiliation(s)
- S Kohzaki
- Department of Radiology, Kitakyushu City Yahata Hospital, 4-18-1 Nishihon-machi, Yahatahigashi, Kitakyushu 850-8534, Japan
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Avni EF, Cassart M, de Maertelaer V, Rypens F, Vermeylen D, Gevenois PA. Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation. Pediatr Radiol 1996; 26:463-9. [PMID: 8662064 DOI: 10.1007/bf01377203] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The aims of the study are to investigate the possible role of ultrasound (US) of the chest in predicting the development of chronic lung disease (CLD) in patients with hyaline membrane disease (HMD) and to determine the optimal age for the sonographic examination. One hundred and five consecutive prematures undergoing mechanical ventilation were prospectively studied by US of the chest. The US examinations were performed at birth and at least once a week until discharge from the neonatal unit. The sonographic patterns observed behind the diaphragm and their evolutions were recorded and correlated with the clinical and radiological data at day 28, which corresponds to the currently accepted limit for determining the presence of CLD. CLD is currently defined as oxygen dependency on day 28 with radiographic abnormalities. A diffuse retrodiaphragmatic hyperechogenicity was observed in all the patients with HMD. The hyperechogenicity resolved completely in patients with an uncomplicated clinical evolution. In contrast, in patients with CLD the hyperechogenicity resolved only partially, resulting in less diffuse and less extensive hyperechogenicity. Day 18 was the earliest day where the persistence of the abnormal retrodiaphragmatic hyperechogenicity was observed in 100% of the patients presenting CLD at day 28. At that time, 95.2% of the patients without abnormal hyperechogenicity showed uncomplicated evolution and no CLD. US can be a useful diagnostic tool to determine the occurrence of CLD and to predict as early as day 18 the prematures at risk for the disease.
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Affiliation(s)
- E F Avni
- Department of Radiology, Erasme Hospital, Route de Lennik 808, B-1070 Brussels, Belgium
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