Tools to assess lung aeration in neonates with respiratory distress syndrome

Abstract

Aim Respiratory distress syndrome is a common condition among preterm neonates, and assessing lung aeration assists in diagnosing the disease and helping to guide and monitor treatment. We aimed to identify and analyse the tools available to assess lung aeration in neonates with respiratory distress syndrome. Methods A systematic review and narrative synthesis of studies published between January 1, 2004, and August 26, 2019, were performed using the OVID Medline, PubMed, Embase and Scopus databases. Results A total of 53 relevant papers were retrieved for the narrative synthesis. The main tools used to assess lung aeration were respiratory function monitoring, capnography, chest X‐rays, lung ultrasound, electrical impedance tomography and respiratory inductive plethysmography. This paper discusses the evidence to support the use of these tools, including their advantages and disadvantages, and explores the future of lung aeration assessments within neonatal intensive care units. Conclusion There are currently several promising tools available to assess lung aeration in neonates with respiratory distress syndrome, but they all have their limitations. These tools need to be refined to facilitate convenient and accurate assessments of lung aeration in neonates with respiratory distress syndrome.

The Role of Lung Ultrasound as an Early Diagnostic Tool for Need of Surfactant Therapy in Preterm Infants with Respiratory Distress Syndrome

“…Recently, LUS has become an attractive new tool for assessing lungs in ventilated critically ill neonates. 1,13,23 Follow-up studies have shown that LUS has a more accurate diagnostic value than CXR in the detection of consolidations. The LUS helps in the differential diagnosis of RDS, interstitial syndrome, pleural effusions, pleural masses, consolidations, pneumothorax, and diaphragmatic dysfunction and provides procedural guidance for various pulmonary procedures such as thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies.…”

“…The LUS helps in the differential diagnosis of RDS, interstitial syndrome, pleural effusions, pleural masses, consolidations, pneumothorax, and diaphragmatic dysfunction and provides procedural guidance for various pulmonary procedures such as thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies. 23,24 In contrast to the adults, the lung structures of neonates, especially of preterm infants are immature. Preterm lungs are smaller, have thinner chest walls, and can be examined with fewer scans.…”

The Associations Between Lung Ultrasonography Scores in the First Day of Life and Clinical Outcomes

“…25 Followup studies showed that LU has a more accurate diagnostic value than CXRs. 26 A recent published review demonstrated LU has a shorter operation time than CXR, and a high concordance with CXR in the differential diagnosis of NRF, and confirms also the high level of accuracy for RDS, TTN, and pneumonia. 27 Another systematic review reported LU has a sensitivity and specificity of 97% and 91%, which were higher than clinical diagnosis and CXR results.…”

Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases

“…Moreover, LUSS requires the assessment of all lung surfaces (i.e., anterior, lateral and posterior) which could be difficult to obtain in critically ill neonates [27]. Notwithstanding, few studies sustained that LUSS had a better sensitivity with respect to the clinical score in pointing out children requiring surfactant replacement, particularly in preterm newborns of <30 weeks of gestational age [28,29]. Perri et al [30] demonstrated that LUSS could be used for the follow-up of newborns treated with surfactant replacement, monitoring the need for a second treatment after 2 h from the first administration.…”