Research paperThoracic ultrasound accuracy for the investigation of initial neonatal respiratory distress
Introduction
Acute respiratory distress is the main cause of disease in the newborn, especially in premature infants. Its management is first based on clinical symptoms, but has to be completed by lung imaging.
Currently, chest x-ray (CXR) is the primary exam in daily practice in pediatric and adult intensive care units, although it has limited diagnostic performance at the patient's bedside. Thoracic ultrasound (TUS) is increasingly used for acute respiratory distress in adults, based on standardized signs [1]. It has shown better diagnostic performance than CXR, sometimes close to those of CT [2], [3]. In pediatric emergency departments, TUS is also suggested to help the diagnosis of respiratory conditions such as bronchiolitis or pneumonia in children [4], [5]. In neonatal units, in spite of a growing literature, TUS is not commonly used to investigate neonatal respiratory symptoms and CXR remains the first-choice exam. The repetition of CXR could increase the risk of malignant diseases in children, and has to be as limited as possible, whereas TUS is easy to perform and can be repeated without any risk of irradiation. Several studies have already confirmed that ultrasound allows diagnosis for specific neonatal conditions [5], [6], [7], [8], [9]. Usefulness and the possible impact of TUS in daily practice in neonatal intensive care must be evaluated.
Our purpose was to perform a pilot study in our neonatal intensive care unit to analyze the diagnostic TUS performance compared to CXR and clinical course, applied to our global population of unselected newborns so as to evaluate the value of TUS and develop it in our daily practice. We hypothesized that TUS diagnostic performance would be equal or higher than CXR performance in determining the causes of respiratory distress, and that TUS could replace CXR in some situations.
Section snippets
Design and settings
We conducted a descriptive, prospective, and single-center diagnostic accuracy study, following STARD (Standards for the Reporting of Diagnostic Accuracy Studies) guidelines. This study took place between 1st January and 31 May 2014, in a tertiary neonatal hospital.
Inclusion criteria
We consecutively included term and preterm newborns who needed a CXR because of respiratory conditions occurring at birth or during the first 24 h of life, and for whom we could perform a TUS less than 3 h before or after the CXR. Only
Patient and exam characteristics
Among the 288 CXRs performed during the study period, 124 were performed on eligible newborns with initial respiratory symptoms. Sixty-six newborns were not included because no trained neonatologist was available to perform the TUS. We were able to perform TUS within 3 h for 58 newborns (46.8%). Six were excluded because of low TUS quality (n = 2) or prenatal suspicion of a malformation (n = 4). Finally, 52 newborns were included and each of the 104 lungs was independently analyzed.
Table 1 shows the
Discussion
This study found excellent diagnostic performance of TUS for the most frequent causes of immediate neonatal respiratory symptoms: RDS, TTN, pneumothorax, pneumomediastinum, and MAS.
Contrary to the present study, most neonatal studies focused on specific conditions in selected newborns. Only one recent study determined ultrasonography performance to identify the etiology of respiratory distress in 63 neonates, using a radiological and clinical gold standard similar to ours, without selecting
Conclusion
TUS has excellent performance for the diagnosis of the main neonatal respiratory diseases and its results are concordant with CXR and clinical progression. This suggests that TUS might replace CXR as the first-choice method, to identify suspected RDS or TTN in newborns and to eliminate differential diagnoses such as pneumothorax and pneumomediastinum. Further studies will be necessary to prove the safety of this practice and determine the impact of TUS in reducing irradiation and improving
Manuscript edition
The American Manuscript Editors edited this manuscript (certificate verification key: 781-132-506-436-208).
Disclosure of interest
The authors declare that they have no competing interest.
References (30)
- et al.
Usefulness of cardiothoracic chest ultrasound in the management of acute respiratory failure in critical care practice
Chest
(2013) Lung ultrasound: its role in neonatology and pediatrics
Early Hum Dev
(2013)- et al.
Lung ultrasound findings in meconium aspiration syndrome
Early Hum Dev
(2014) - et al.
Lung ultrasound for the diagnosis of severe neonatal pneumonia
Chest
(2014) The neonatal chest
Eur J Radiol
(2006)- et al.
Lung ultrasonography to diagnose transient tachypnea of the newborn
Chest
(2016) - et al.
Pulmonary ultrasonography in the follow-up of respiratory distress syndrome on preterm newborns. Reduction of X-ray exposure
J Ultrasound
(2011) - et al.
Confirmation of correct tracheal tube placement in newborn infants
Resuscitation
(2013) - et al.
International evidence-based recommendations for point-of-care lung ultrasound
Intensive Care Med
(2012) - et al.
Lung ultrasound in critically ill patients: comparison with bedside chest radiography
Intensive Care Med
(2011)
Ultrasound detection of pneumonia in febrile children with respiratory distress: a prospective study
Eur J Pediatr
Lung ultrasound accuracy in respiratory distress syndrome and transient Tachypnea of the newborn
Neonatology
Routine application of lung ultrasonography in the neonatal intensive care unit
Medicine (Baltimore)
Chest ultrasound in children: critical appraisal
Pediatr Radiol
Diagnosis of neonatal transient tachypnea and its differentiation from respiratory distress syndrome using lung ultrasound
Medicine (Baltimore)
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