The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity

Luca, Danièle De; Kaam, Anton H. van; Tingay, David G.; Courtney, Sherry E.; Danhaive, Olivier; Carnielli, Virgilio P.; Zimmermann, Luc J. I.; Kneyber, Martin C. J.; Tissières, Pierre; Brierley, Joe; Conti, Giorgio; Pillow, J. Jane; Rimensberger, Peter C.

doi:10.1016/s2213-2600(17)30214-x

Cited by 230 publications

(209 citation statements)

References 89 publications

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“…TTN was clinically defined as the presence of tachypnea (respiratory rate > 60/min) and dyspnea (Silverman score > 1) appearing within the first 24 h of life, needing only oxygen supplementation and/or nasal continuous airway pressure (CPAP). Exclusion criteria were: (1) major malformations or chromosomal abnormalities; (2) early-onset sepsis or pneumonia (defined by the presence of clinical, radiological, and microbiological criteria as detailed elsewhere [8]) and increased inflammatory markers as per local NICU protocols, or the diagnosis of clinical chorioamnionitis (defined elsewhere [9]); (3) lack of parental consent; (4) a diagnosis of neonatal acute respiratory distress syndrome according to the Montreux definition [10]; (5) a diagnosis of classical hyaline membrane disease, i.e., respiratory distress syndrome (RDS) (as previously described [10]). Basically, RDS was defined as the presence of typical chest X-rays (a diffuse ground-glass appearance) and the need for surfactant replacement.…”

Section: Methodsmentioning

confidence: 99%

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

Raimondi

Yousef

Fanjul³

et al. 2019

Neonatology

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Background and Aim: Discordant results that demand clarification have been published on diagnostic lung ultrasound (LUS) signs of transient tachypnea of the neonate (TTN) in previous cross-sectional, single-center studies. This work was conducted to correlate clinical and imaging data in a longitudinal and multicenter fashion. Methods: Neonates with a gestational age of 34–40 weeks and presenting with TTN underwent a first LUS scan at 60–180 min of life. LUS scans were repeated every 6–12 h if signs of respiratory distress persisted. Images were qualitatively described and a LUS aeration score was calculated. Clinical data were collected during respiratory distress. Results: We enrolled 65 TTN patients. Thirty-one (47.6%) had a sharp echogenicity increase in the lower lung fields (the “double lung point” or DLP sign). On admission, there was no significant difference between patients with and without DLP in Silverman scores (4 ± 1.5 vs. 4 ± 2.1; p = 0.9) or LUS scores (7.6 ± 2.6 vs. 5.6 ± 3.8; p = 0.12); PaO₂/FiO₂ (249 ± 93 vs. 252 ± 125; p = 0.91). All initial LUS scans (performed at the onset of distress) and 99.5% of all scans showed a regular pleural line with no consolidation, with only 1 neonate showing consolidation in the follow-up scans. The Silverman and LUS scores were significantly correlated (rho = 0.27; p = 0.02). Conclusion: A regular pleural line with no consolidation is a consistent finding in TTN. The presence of a DLP is not essential for the LUS diagnosis of TTN. A semi-quantitative LUS score correlates well with the clinical course and could be useful in monitoring changes in lung aeration during TTN.

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Section: Methodsmentioning

confidence: 99%

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

Raimondi

Yousef

Fanjul³

et al. 2019

Neonatology

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“…Neonatal ARDS ARDS is an acute, life-threatening respiratory failure, characterised by extensive lung tissue inflammation, endothelial injury and both quantitative and qualitative secondary surfactant dysfunction, leading to loss of lung aeration. 25 Neonatal ARDS shares the same biological and pathophysiological aspects of the syndrome in The basic semiology patterns are illustrated: these patterns may be variably found in different respiratory disorders described in Table 1. Arrows indicate the sub-pleural consolidation, the border of a consolidation, the double lung point or the lung point.…”

Section: Respiratory Distress Syndromementioning

confidence: 99%

“…26 Lung imaging is one of the diagnostic criteria included in the Montreux definition of neonatal ARDS, but this officially requires X-ray findings (diffuse, bilateral and irregular opacities or infiltrates, or complete opacification of the lungs, which are not fully explained by local effusion, atelectasis, RDS, TTN or congenital lung anomalies). 25 Nonetheless, LUS has been used for the diagnosis of ARDS in adults 27 and is considered suitable in neonates if sufficient clinical expertise exists for its interpretation. 28 Despite similarities with the syndrome in older patients, neonatal ARDS may also have different triggers, such as meconium aspiration syndrome (MAS), lung haemorrhage, perinatal asphyxia or necrotising enterocolitis that are peculiar to newborn age.…”

Section: Respiratory Distress Syndromementioning

confidence: 99%

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

et al. 2018

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Lung ultrasound (LUS) is the latest amongst imaging techniques: it is a radiation-free, inexpensive, point-of-care tool that the clinician can use at the bedside. This review summarises the rapidly growing scientific evidence on LUS in neonatology, dividing it into descriptive and functional applications. We report the description of the main ultrasound features of neonatal respiratory disorders and functional applications of LUS aiming to help a clinical decision (such as surfactant administration, chest drainage etc). Amongst the functional applications, we propose SAFE (Sonographic Algorithm for liFe threatening Emergencies) as a standardised protocol for emergency functional LUS in critical neonates. SAFE has been funded by a specific grant issued by the European Society for Paediatric Research. Future potential development of LUS in neonatology might be linked to its quantitative evaluation: we also discuss available data and research directions using computer-aided diagnostic techniques. Finally, tools and opportunities to teach LUS and expand the research network are briefly presented.

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“…Furthermore, chest radiograph findings can "lag" behind clinical deterioration [238,239] such that patients with refractory shock and a "negative" chest radiograph may still progress toward more overt ARDS. Lung ultrasound may provide an alternative tool to chest radiograph in detecting lung pathology, but its utility to identify which sepsis patients may benefit from early mechanical ventilation is not yet clear [240][241][242][243]. For these reasons, 48% of panel members often or always and 35% sometimes intubate children with fluid-refractory, catecholamine-resistant septic shock even in the absence of clear respiratory failure, while 17% rarely or never do so.…”

mentioning

confidence: 99%

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity

Cited by 230 publications

References 89 publications

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

A Multicenter Lung Ultrasound Study on Transient Tachypnea of the Neonate

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

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

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