Introduction of point-of-care neonatal lung ultrasound in a developing country

Mazmanyan, Pavel; Kerobyan, Varsenik V.; Shankar-Aguilera, Shivani; Yousef, Nadya; Luca, Danièle De

doi:10.1007/s00431-020-03603-w

Cited by 31 publications

(14 citation statements)

References 28 publications

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“…Lung ultrasound also has additional interesting characteristics. It may reduce radiation exposure [51], and basic lung ultrasound semiology is successfully recognized with any type of probe and with high agreement between physicians of different expertise [52,53] while the learning curve is steep also in developing countries [54]. Consistently, lung ultrasound has been recently listed amongst the point-of-care ultrasound to be used in paediatric and neonatal critical care whose evidence-based guidelines have been recently released [55].…”

Section: Functional Lung Imaging: Lung Ultrasoundmentioning

confidence: 99%

Personalized Medicine for the Management of RDS in Preterm Neonates

et al. 2021

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Continuous positive airway pressure and surfactant represent the first- and second-line treatment for respiratory distress syndrome in preterm neonates, as European and American guidelines, since 2013 and 2014, respectively, started to recommend surfactant replacement only when continuous positive airway pressure fails. These recommendations, however, are not personalized to the individual physiopathology. Simple clinical algorithms may have improved the diffusion of neonatal care, but complex medical issues can hardly be addressed with simple solutions. The treatment of respiratory distress syndrome is a complex matter and can be only optimized with personalization. We performed a review of tools to individualize the management of respiratory distress syndrome based on physiopathology and actual patients’ need, according to precision medicine principles. Advanced oxygenation metrics, lung ultrasound, electrical impedance tomography, and both quantitative and qualitative surfactant assays were examined. When these techniques were investigated with diagnostic accuracy studies, reliability measures have been meta-analysed. Amongst all these tools, quantitative lung ultrasound seems the more developed for the widespread use and has a higher diagnostic accuracy (meta-analytical AUC = 0.952 [95% CI: 0.951–0.953]). Surfactant adsorption (AUC = 0.840 [95% CI: 0.824–0.856]) and stable microbubble test (AUC = 0.800 [95% CI: 0.788–0.812]) also have good reliability, but need further industrial development. We advocate for a more accurate characterization and a personalized approach of respiratory distress syndrome. With the above-described currently available tools, it should be possible to personalize the treatment of respiratory distress syndrome according to physiopathology.

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Section: Functional Lung Imaging: Lung Ultrasoundmentioning

confidence: 99%

Personalized Medicine for the Management of RDS in Preterm Neonates

et al. 2021

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“…Recently, a simplified image system similar to the one used in the present study was introduced after a short formal training in a low-income Fig. 1 Comparative ROC analysis, including both the three-image (3P-LUS) and the full lung ultrasound score (full-LUS), performed using the method by DeLong et al [20] setting: the simplified scoring system, although less accurate than the full LUS, proved to be useful to recognise RDS and TTN, providing a non-invasive and easily available tool to be integrated to clinical evaluation [28]. Beyond TTN and RDS [29], LUS in neonatal medicine has proved its usefulness in the detection of several other conditions, such as pneumothorax, pleural effusions, consolidations and atelectasis [7], and will hopefully give new insights in the management of non-respiratory diseases such as congenital heart disease [30].…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section

Poerio¹,

Galletti

Baldazzi³

et al. 2020

Eur J Pediatr

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We aimed to evaluate the reliability of lung ultrasound (LU) to predict admission to the neonatal intensive care unit (NICU) for transient neonatal tachypnoea or respiratory distress syndrome in infants born by caesarean section (CS). A prospective, observational, single-centre study was performed in the delivery room and NICU of Sant’Orsola-Malpighi Hospital in Bologna, Italy. Term and late-preterm infants born by CS were included. LU was performed at 30’ and 4 h after birth. LU appearance was graded according to a previously validated three-point scoring system (3P-LUS: type-1, white lung; type-2, black/white lung; type-3, normal lung). Full LUS was also calculated. One hundred infants were enrolled, and seven were admitted to the NICU. The 5 infants with bilateral type-1 lung at birth were all admitted to the NICU. Infants with type-2 and/or type-3 lung were unlikely to be admitted to the NICU. Mean full-LUS was 17 in infants admitted to the NICU, and 8 in infants not admitted. In two separate binary logistic regression models, both the 3P- and the full LUS proved to be independently associated with NICU admission (OR [95% CI] 0.001 [0.000–0.058], P = .001, and 2.890 [1.472–5.672], P = .002, respectively). The ROC analysis for the 3P-LUS yielded an AUC of 0.942 (95%CI, 0.876–0.979; P<.001), while ROC analysis for the full LUS yielded an AUC of 0.978 (95%CI, 0.926–0.997; P<.001). The AUCs for the two LU scores were not significantly different (p = .261). Conclusion: the 3P-LUS performed 30 min after birth proved to be a reliable tool to identify, among term and late preterm infants born to CS, those who will require NICU admission for transient neonatal tachypnoea or respiratory distress syndrome. What is known• Lung ultrasound (LU) has become an attractive diagnostic tool in neonatal settings, and guidelines on point-of-care LU in the neonatal intensive care unit (NICU) have been recently issued.• LU is currently used for diagnosing several neonatal respiratory morbidities and has been also proposed for predicting further intervention, such as NICU admission, need for surfactant treatment or mechanical ventilation in preterm infants. What is new• LU performed 30′ after birth and evaluated through a simple three-point scoring system represents a reliable tool to identify, among term and late preterm infants born to caesarean section, those with transient neonatal tachypnoea or respiratory distress syndrome who will require NICU admission.• LU performed in the neonatal period confirms its potential role in ameliorating routine neonatal clinical management.

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“…and "how to increase the diffusion of the technique?" Lung ultrasound has a steep learning curve 50 and it has been easily introduced in developing countries, 51 but we do not have yet enough formal data about its training, while these are available in adult critical care.…”

Section: New Tools 31 Lung Ultrasoundmentioning

confidence: 99%

Respiratory distress syndrome in preterm neonates in the era of precision medicine: A modern critical care-based approach

Luca

2021

Pediatrics & Neonatology

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Introduction of point-of-care neonatal lung ultrasound in a developing country

Cited by 31 publications

References 28 publications

Personalized Medicine for the Management of RDS in Preterm Neonates

Personalized Medicine for the Management of RDS in Preterm Neonates

Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section

Respiratory distress syndrome in preterm neonates in the era of precision medicine: A modern critical care-based approach

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