Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport

Abstract

Purpose Lung ultrasound (LUS) at the point‐of‐care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. Methods LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X‐ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. Results LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5‐98.5%), and specificity was 92.6% (95%CI: 74.2‐98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0‐85.9%) and 81.5% (95%CI: 61.2‐92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5‐99.1%) and a specificity of 100% (95%CI: 89.9‐100%). For CXR, sensitivity was 16.7% (95%CI: 0.01‐63.5%) and specificity was 97.7% (95%CI: 86.4‐99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI: 0.40‐0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI: 0.74‐0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. Conclusion LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.

Lung Ultrasound for the Diagnosis of Neonatal Respiratory Distress Syndrome

“…Therefore, 10 studies were ultimately included in the present meta-analysis. [23][24][25][26][27][28][29][30][31][32] Manual searching of the reference cited in these 10 studies did not yield any additional relevant studies. A flow chart depicting the literature search is presented in Figure 1.…”

“…As indicated in Table 1, the 10 included studies with a total of 887 neonates were published between 1990 and 2019 and written in English. Among the studies, 7 were prospective cohort studies, 23,24,26,28,[30][31][32] and 3 were case-control studies. 25,27,29 The mean number of neonates per study was 88.7 (range, 40-146).…”

“…25,27,29 The mean number of neonates per study was 88.7 (range, 40-146). Six studies were conducted in Europe, [23][24][25]28,30,32 and 4 studies in Asia. 26,27,29,31 Eight studies 24,[26][27][28][29][30][31][32] reported sex ratios: 58.7% of neonates were male, and 41.3% were female.…”

“…25,27,29 Concerning the index test domain, 1 study 23 was considered as unknown because the blinded status was not explicitly reported; 4 studies were labeled as having high bias because the researchers were not blinded to the reference standard at the time of interpretation of LUS. 25,26,29,32 Regarding the reference standard domain, 1 study 23 was considered as unknown because the blinded status was not explicitly reported. With regard to the flow and timing domain, 7 studies were considered as unknown because they reported the interval between LUS and CXR as less than 24 hours but failed to supply more accurate timing.…”

“…Subgroup analysis of 5 studies 25,27,28,31,32 using a transthoracic technique showed pooled sensitivity of 0.88 (95% CI, 0.84-0.91) and specificity of 0.98 (95% CI, 0.96-1.00), respectively, with the SROC AUC of 0.9893; in comparison, 3 studies 23,24,26 using a transabdominal scanning technique revealed pooled sensitivity of 0.96 (95% CI, 0.92-0.99) and specificity of 0.85 (95% CI, 0.77-0.92), respectively, with the SROC AUC of 0.9463.…”