Decoding the neonatal chest radiograph: An insight into neonatal respiratory distress

Jain, Sanjay N; Modi, Tanvi; Varma, Ravi

doi:10.4103/ijri.ijri_281_20

Cited by 5 publications

(6 citation statements)

References 12 publications

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“…A second dose of surfactant at 100 mg/kg of phospholipid was administered if the FiO2 value remained above the cutoff ( 9 ). Apart from this, SpO2/FiO2 ratio and a/A ratio were calculated for all the neonates prior to surfactant therapy, and CXR grading was done based on the radiological characteristics, namely, reticulogranular pattern, radiolucency, cardiac silhouette, and air-bronchograms—Stage 1: fine granular pattern with few air-bronchograms; Stage 2: distinct granularity and excessive air-bronchograms; Stage 3: increased opacity with reduced air-bronchograms; and Stage 4: diffuse bilateral opacified lung (white-out) with lack of cardiac borders and loss of all air-bronchograms ( 17 ).…”

Section: Methodsmentioning

confidence: 99%

Diagnostic utility of lung ultrasound in predicting the need for surfactant therapy in preterm neonates with respiratory distress

Singh,

Patnaik,

Verma

et al. 2023

Front. Pediatr.

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BackgroundLung ultrasound is an accurate and early predictor for surfactant replacement therapy in respiratory distress syndrome (RDS) as compared to clinical parameters and chest x-ray. However, lung pathologies for respiratory distress at birth have overlapping symptomatology and low middle-income countries have a higher incidence of congenital pneumonia, in addition to RDS, making the immediate diagnosis difficult. Thus, there is a need for assessing a cutoff for lung ultrasound scores in the given setting.ObjectivesThe primary objective was to determine the diagnostic accuracy of the lung ultrasound score (LUS) in predicting the need for surfactant therapy in preterm neonates with respiratory distress. Secondary objectives were to correlate LUS with corresponding oxygen saturation to the fraction of inspired oxygen ratio (SpO2/FiO2), arterial/Alveolar oxygen pressure ratio (a/A), and chest x-ray (CXR) findings.MethodologyA prospective observational study was carried out at a tertiary-level neonatal intensive care unit in India in 2022 enrolling 100 neonates <34 weeks gestational age with respiratory distress at birth. After initial stabilization of the neonate, LUS was performed and baseline parameters were noted. Surfactant was administered as per the 2019 European Consensus guidelines and LUS was repeated after 6 h of therapy.ResultsThe mean gestation of enrolled neonates was 31.06 ± 2.12 weeks and the mean birthweight was 1,412 ± 391 g. Approximately 58% were diagnosed with RDS and 30% had congenital pneumonia. Surfactant was administered to 40% of neonates. The cutoff LUS for surfactant therapy was 7 [area under the curve (AUC) 0.977; 95% CI, 0.947–1; P < 0.001; with sensitivity 92.5%, specificity 96.67%, PPV 94.87%, and NPV 95.08%] and the cutoff LUS for the second dose of surfactant was 10 (AUC 0.964; 95% CI, 0.913–1; P < 0.001). The score decreased by 3.24 (2.44–4.05) after 6 h of the first dose and correlated significantly with SpO2/FiO2 ratio (−0.750), a/A ratio (−0.650), and CXR findings (0.801).ConclusionThe study predicted an optimal LUS cutoff of 7 and 10 for the need for the first dose of surfactant and re-treatment, respectively, in neonates <34 weeks gestational age with respiratory distress.

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Section: Methodsmentioning

confidence: 99%

Diagnostic utility of lung ultrasound in predicting the need for surfactant therapy in preterm neonates with respiratory distress

Singh,

Patnaik,

Verma

et al. 2023

Front. Pediatr.

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“…54 Consolidated areas larger than 1 cm, not the smaller micro-consolidated areas, are likely to be seen on radiographs. 1,31,55,56 Air bronchograms: Dense, snowflake like areas seen in (severe) RDS and pneumonia.…”

Section: Pleural Linesmentioning

confidence: 99%

“…63,64 Traditional chest radiographs for RDS generally show pan-opacified lungs, where it might be difficult to differentiate pulmonary edema from pleural effusion. 55,65 Lung ultrasound can add to chest radiographs by defining various pathologies such as atelectasis, consolidation, pulmonary edema, and pleural effusion. 66,67 These findings in sonography correlate with the difference in the response of each infant to surfactant and RDS management.…”

Section: Assessment Of the Severity Of Rds And The Need For Surfactantmentioning

confidence: 99%

Lung Ultrasound in Neonates: An Emerging Tool for Monitoring Critically Ill Infants

Maheshwari¹,

Suryawanshi²,

Paul³

et al. 2023

Newborn

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Context: Neonatal lung ultrasound is emerging as a useful clinical tool for the assessment of lung anatomy and management of various lung pathologies. In this review, we summarize normal lung ultrasound (LUS) findings and specific features of various lung morbidities. Evidence acquisition: A comprehensive literature search was conducted across multiple sources with relevant keywords with an additional filter of the age-group between 0 and 28 days. Findings: Apart from the description of normal newborn lungs, clinical and radiological features of a variety of lung pathologies were evaluated and incorporated in the review. Bedside LUS has evolved to be an important point-of-care imaging modality that can help in day-to-day clinical decision-making. It can be used in differentiating respiratory distress syndrome from transient tachypnea on the newborns, in the detection of pneumothorax, and in diagnosing pneumonia, pulmonary hemorrhage, and pleural effusion. Evidence supports the use of LUS scores to decide on the need for early rescue surfactant therapy with high sensitivity and specificity. Lung ultrasound scores obtained during the first 2 weeks after birth can help predict the likelihood of chronic lung disease/bronchopulmonary dysplasia. Once validated, it could be valuable for guiding early intervention and evaluation of new treatments. Conclusion: Neonatal lung ultrasound is emerging as a vital monitoring tool in critically ill infants with lung disease. It will be valuable in the early diagnosis, management, and prognosis of these patients.

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“…Abnormalities in infant chest radiography can represent wide differential diagnoses depending on the age of presentation, gestational age, and clinical scenario 1 . Often, patients will present with signs of respiratory distress or hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

“…

Abnormalities in infant chest radiography can represent wide differential diagnoses depending on the age of presentation, gestational age, and clinical scenario. 1 Often, patients will present with signs of respiratory distress or hypoxemia. However, in this case, we describe a previously healthy 6-month-old infant presenting with failure to thrive (FTT), emesis, jaundice, and an abnormal chest radiograph (CXR) without overt signs of respiratory distress.

| CASE PRESENTATIONThe pulmonology service was consulted to evaluate abnormal radiographic findings in a 6-month-old female admitted for progressive weight loss.

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mentioning

confidence: 99%

When lungs and weights tell different stories

Godse,

Brumer,

Kizilirmak

et al. 2024

Pediatric Pulmonology

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Decoding the neonatal chest radiograph: An insight into neonatal respiratory distress

Cited by 5 publications

References 12 publications

Diagnostic utility of lung ultrasound in predicting the need for surfactant therapy in preterm neonates with respiratory distress

Diagnostic utility of lung ultrasound in predicting the need for surfactant therapy in preterm neonates with respiratory distress

Lung Ultrasound in Neonates: An Emerging Tool for Monitoring Critically Ill Infants

When lungs and weights tell different stories

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