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Neonatal lung ultrasound exam guidelines

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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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References

  1. 1

    Hall EJ . Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 2002; 32 (10): 700–706.

  2. 2

    Lichtenstein D . Lung ultrasound in acute respiratory failure an introduction to the BLUE-protocol. Minerva Anestesiol 2009; 75 (5): 313–317.

  3. 3

    Cattarossi L . Lung ultrasound: its role in neonatology and pediatrics. Early Hum Dev 2013; 89 (Suppl 1): S17–S19.

  4. 4

    Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ . Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004; 100 (1): 9–15.

  5. 5

    Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 2011; 37 (9): 1488–1493.

  6. 6

    Lichtenstein DA, Mauriat P . Lung ultrasound in the critically ill neonate. Curr Pediatr Rev 2012; 8 (3): 217–223.

  7. 7

    Liu J . Lung ultrasonography for the diagnosis of neonatal lung disease. J Matern Fetal Neonatal Med 2014; 27 (8): 856–861.

  8. 8

    Copetti R, Cattarossi L. Lung ultrasound in newborns, infants, and children. In: Mathis G (ed). Chest Sonography, 3rd edn. Springer: Berlin, Heidelberg: New York, 2011.

  9. 9

    Avni EF, Cassart M, de Maertelaere V, Rypens F, Vermeylen D, Gevenois PA . Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation. Pediatr Radiol 1996; 26 (7): 463–469.

  10. 10

    Raimondi F, Migliaro F, Sodano A, Ferrara T, Lama S, Vallone G et al. Use of neonatal chest ultrasound to predict noninvasive ventilation failure. Pediatrics 2014; 134 (4): e1089–e1094.

  11. 11

    Rodriguez-Fanjul J, Balcells C, Aldecoa-Bilbao V, Moreno J, Iriondo M . Lung ultrasound as a predictor of mechanical ventilation in neonates older than 32 weeks. Neonatology 2016; 110 (3): 198–203.

  12. 12

    Raimondi F, Migliaro F, Sodano A, Umbaldo A, Romano A, Vallone G et al. Can neonatal lung ultrasound monitor fluid clearance and predict the need of respiratory support? Crit Care 2012; 16 (6): R220.

  13. 13

    Vitale V, Ricci Z, Cogo P . Lung ultrasonography and pediatric cardiac surgery: first experience with a new tool for postoperative lung complications. Ann Thorac Surg 2014; 97 (4): e121–e124.

  14. 14

    Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D . Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr 2015; 169 (8): e151797.

  15. 15

    Martelius L, Suvari L, Janer C, Helve O, Kaskinen A, Kirjavainen T et al. Lung ultrasound and static lung compliance during postnatal adaptation in healthy term infants. Neonatology 2015; 108 (4): 287–292.

  16. 16

    Liu J, Cao HY, Fu W . Lung ultrasonography to diagnose meconium aspiration syndrome of the newborn. J Int Med Res 2016; 44: 1534–1542.

  17. 17

    Lichtenstein DA, Menu Y . A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding. Chest 1995; 108 (5): 1345–1348.

  18. 18

    Lichtenstein DA, Meziere G, Lascols N, Biderman P, Courret JP, Gepner A et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33 (6): 1231–1238.

  19. 19

    Volpicelli G, Caramello V, Cardinale L, Mussa A, Bar F, Frascisco MF . Detection of sonographic B-lines in patients with normal lung or radiographic alveolar consolidation. Med Sci Monit 2008; 14 3: Cr122–Cr128.

  20. 20

    Lichtenstein DA, Lascols N, Meziere G, Gepner A . Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 2004; 30 (2): 276–281.

  21. 21

    Copetti R, Cattarossi L . The 'double lung point': an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology 2007; 91 (3): 203–209.

  22. 22

    Liu J, Wang Y, Fu W, Yang CS, Huang JJ . Diagnosis of neonatal transient tachypnea and its differentiation from respiratory distress syndrome using lung ultrasound. Medicine 2014; 93 (27): e197.

  23. 23

    Liu J, Chen XX, Li XW, Chen SW, Wang Y, Fu W . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest 2016; 149 (5): 1269–1275.

  24. 24

    Vergine M, Copetti R, Brusa G, Cattarossi L . Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology 2014; 106 (2): 87–93.

  25. 25

    Avni EF, Braude P, Pardou A, Matos C . Hyaline membrane disease in the newborn: diagnosis by ultrasound. Pediatr Radiol 1990; 20 (3): 143–146.

  26. 26

    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 (1): 52–59.

  27. 27

    Bober K, Swietlinski J . Diagnostic utility of ultrasonography for respiratory distress syndrome in neonates. Med Sci Monit 2006; 12 (10): Cr440–Cr446.

  28. 28

    El-Malah HE-DGM, Hany S, Mahmoud MK, Ali AM . Lung ultrasonography in evaluation of neonatal respiratory distress syndrome. Egypt J Radiol Nucl Med 2015; 46 (2): 469–474.

  29. 29

    Liu J, Cao HY, Wang HW, Kong XY . The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr 2015; 25 (1): e323.

  30. 30

    Lovrenski J . Lung ultrasonography of pulmonary complications in preterm infants with respiratory distress syndrome. Ups J Med Sci 2012; 117 (1): 10–17.

  31. 31

    Lovrenski J, Sorantin E, Stojanovic S, Doronjski A, Lovrenski A . Evaluation of surfactant replacement therapy effects—a new potential role of lung ultrasound. Srp Arh Celok Lek 2015; 143 (11-12): 669–675.

  32. 32

    Sawires HK, Abdel Ghany EA, Hussein NF, Seif HM . Use of lung ultrasound in detection of complications of respiratory distress syndrome. Ultrasound Med Biol 2015; 41 (9): 2319–2325.

  33. 33

    Lichtenstein D, Meziere G, Biderman P, Gepner A . The "lung point": an ultrasound sign specific to pneumothorax. Intensive Care Med 2000; 26 (10): 1434–1440.

  34. 34

    Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38 (4): 577–591.

  35. 35

    Caiulo VA, Gargani L, Caiulo S, Fisicaro A, Moramarco F, Latini G et al. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol 2013; 48 (3): 280–287.

  36. 36

    Liu J, Liu F, Liu Y, Wang HW, Feng ZC . Lung ultrasonography for the diagnosis of severe neonatal pneumonia. Chest 2014; 146 (2): 383–388.

  37. 37

    Liu J, Chen SW, Liu F, Li QP, Kong XY, Feng ZC . The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest 2015; 147 (4): 1013–1019.

  38. 38

    Lichtenstein D, Meziere G, Seitz J . The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. Chest 2009; 135 (6): 1421–1425.

  39. 39

    Piastra M, Yousef N, Brat R, Manzoni P, Mokhtari M, De Luca D . Lung ultrasound findings in meconium aspiration syndrome. Early Hum Dev 2014; 90 (Suppl 2): S41–S43.

  40. 40

    Liu J, Chen SW, Liu F, Wang Y, Kong XY, Li QP et al. BPD, not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Medicine 2014; 93 (23): e133.

  41. 41

    Pieper CH, Smith J, Brand EJ . The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia. Pediatr Radiol 2004; 34 (3): 227–231.

  42. 42

    Colins JD, Burwell D, Furmanski S, Lorber P, Steckel RJ . Minimal detectable pleural effusions. A roentgen pathology model. Radiology 1972; 105 (1): 51–53.

  43. 43

    Gryminski J, Krakowka P, Lypacewicz G . The diagnosis of pleural effusion by ultrasonic and radiologic techniques. Chest 1976; 70 (1): 33–37.

  44. 44

    Kelbel C, Borner N, Schadmand S, Klose KJ, Weilemann LS, Meyer J et al. [Diagnosis of pleural effusions and atelectases: sonography and radiology compared]. Rofo 1991; 154 (2): 159–163.

  45. 45

    Song IK, Kim EH, Lee JH, Ro S, Kim HS, Kim JT . Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia 2017; 2017: 214–222.

  46. 46

    Cattarossi L, Roberto Copetti R, Brusa G, Pintaldi S . Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax. Canadian Respiratory Journal. 2016; 2016: 6515069.

  47. 47

    Migliaro F, Sodano A, Capasso L, Raimondi F . Lung ultrasound-guided emergency pneumothorax needle aspiration in a very preterm infant. BMJ Case Rep 2014; 2014.

  48. 48

    Hill A, Perlman JM, Volpe JJ . Relationship of pneumothorax to occurrence of intraventricular hemorrhage in the premature newborn. Pediatrics 1982; 69 (2): 144–149.

  49. 49

    Rankin JH, Elkhunovich M, Seif D, Chilstrom M . Point-of-care ultrasound diagnosis of diaphragmatic hernia in an infant with respiratory distress. Pediatr Emerg Care 2016; 32 (10): 731–733.

  50. 50

    Brusa G, Savoia M, Vergine M, Bon A, Copetti R, Cattarossi L . Neonatal lung sonography: interobserver agreement between physician interpreters with varying levels of experience. J Ultrasound Med 2015; 34 (9): 1549–1554.

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Acknowledgements

We specially thank Dr Jing Liu for his mentorship and Dr Richard Schanler who helped edit this article.

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Correspondence to D Kurepa.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Kurepa, D., Zaghloul, N., Watkins, L. et al. Neonatal lung ultrasound exam guidelines. J Perinatol 38, 11–22 (2018) doi:10.1038/jp.2017.140

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