Can neonatal lung ultrasound monitor fluid clearance and predict the need of respiratory supportReport as inadecuate




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Critical Care

, 16:R220

First Online: 14 November 2012Received: 10 April 2012Revised: 12 September 2012Accepted: 09 November 2012

Abstract

IntroductionAt birth, lung fluid is rapidly cleared to allow gas exchange. As pulmonary sonography discriminates between liquid and air content, we have used it to monitor extrauterine fluid clearance and respiratory adaptation in term and late preterm neonates. Ultrasound data were also related to the need for respiratory support.

MethodsConsecutive infants at 60 to 120 minutes after birth underwent lung echography. Images were classified using a standardized protocol of adult emergency medicine with minor modifications. Neonates were assigned to type 1 white lung image, type 2 prevalence of comet-tail artifacts or B-lines or type 3 profiles prevalence of horizontal or A lines. Scans were repeated at 12, 24 and 36 hours. The primary endpoint was the number of infants admitted to the neonatal ICU NICU by attending staff who were unaware of the ultrasound. Mode of respiratory support was also recorded.

ResultsA total of 154 infants were enrolled in the study. Fourteen neonates were assigned to the type 1, 46 to the type 2 and 94 to the type 3 profile. Within 36 hours there was a gradual shift from types 1 and 2 to type 3. All 14 type 1 and 4 type 2 neonates were admitted to the NICU. Sensitivity was 77.7%, specificity was 100%, positive predictive value was 100%, negative predictive value was 97%. Four type 1 infants were mechanically ventilated.

ConclusionsIn the late preterm and term neonate, the lung ultrasound scan follows a reproducible pattern that parallels the respiratory status and can be used as a predictor of respiratory support.

AbbreviationsHMDhyaline membrane disease

IUGRintrauterine growth retardation

NICUneonatal intensive care unit

N-CPAPnasal continuous positive airways pressure

NPVnegative predictive value

PPVpositive predictive value

RDrespiratory distress

TTNtransient tachypnea of the neonate.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11865 contains supplementary material, which is available to authorized users.

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Author: Francesco Raimondi - Fiorella Migliaro - Angela Sodano - Angela Umbaldo - Antonia Romano - Gianfranco Vallone - Letizia Cap

Source: https://link.springer.com/



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