Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax

Abstract

Background. Pneumothorax (PTX) still remains a common cause of morbidity in critically ill and ventilated neonates. At the present time, lung ultrasound (LUS) is not included in the diagnostic work-up of PTX in newborns despite of excellent evidence of reliability in adults. The aim of this study was to compare LUS, chest X-ray (CXR), and chest transillumination (CTR) for PTX diagnosis in a group of neonates in which the presence of air in the pleural space was confirmed. Methods. In a 36-month period, 49 neonates with respiratory distress were enrolled in the study. Twenty-three had PTX requiring aspiration or chest drainage (birth weight 2120 ± 1640 grams; gestational age = 36 ± 5 weeks), and 26 were suffering from respiratory distress without PTX (birth weight 2120 ± 1640 grams; gestational age = 34 ± 5 weeks). Both groups had done LUS, CTR, and CXR. Results. LUS was consistent with PTX in all 23 patients requiring chest aspiration. In this group, CXR did not detect PTX in one patient while CTR did not detect it in 3 patients. Sensitivity and specificity in diagnosing PTX were therefore 1 for LUS, 0.96 and 1 for CXR, and 0.87 and 0.96 for CTR. Conclusions. Our results confirm that also in newborns LUS is at least as accurate as CXR in the diagnosis of PTX while CTR has a lower accuracy.

Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications

“…Recently, a case report and two diagnostic accuracy studies suggest that LUS may also be very useful in the diagnosis of neonatal PNX. [33][34][35] In critically ill babies, LUS can be used for rapid detection of life-threatening tension PNX: an international multicentre study confirmed that LUS has an optimal diagnostic accuracy and is quicker than conventional radiology. 36 LUS also resulted more accurately than chest transillumination (which is also less accurate than conventional radiology).…”

“…36 LUS also resulted more accurately than chest transillumination (which is also less accurate than conventional radiology). 34 A case report described the use of LUS to detect and follow up neonatal interstitial emphysema. 37 No formal LUS description of neonatal pneumomediastinum exists.…”

A newborn infant with respiratory distress: More than meets the eye

“…Chest transillumination is commonly used to diagnose neonatal pneumothorax, although the sensitivity and specificity are inferior to chest X-ray. 7 One small study found the diagnostic accuracy of lung ultrasound similar to chest X-ray, 7 but widespread use of ultrasound at present is limited.…”

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

“…For these reasons, in many neonatal intensive care units (NICUs), LUS is replacing chest X-rays in diagnosing PTX due to its superior sensitivity and specificity [15][16][17] . Moreover, LUS has been shown to be more accurate than chest X-rays even for small, non-tension PTX 18,19,20,21,22,23,24,25,26,27 . LUS signs of PTX were first studied and described in adult critical patients.…”