Chest
Volume 149, Issue 5, May 2016, Pages 1269-1275
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Original Research: Pulmonary Procedures
Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn

https://doi.org/10.1016/j.chest.2015.12.024Get rights and content

Background

This study explored the sensitivity and specificity of ultrasound for diagnosing transient tachypnea of the newborn (TTN).

Methods

Ultrasound was performed by one export. Patients were placed in a supine, lateral recumbent, or prone position. The probe was placed perpendicular or parallel to the ribs, and each region of the lung was scanned. The scan results were compared with conventional chest radiographic results.

Results

A total of 1,358 infants were included in this study. We identified 412 cases without pulmonary diseases, 228 TTN cases, 358 respiratory distress syndrome (RDS) cases, 85 meconium aspiration syndrome (MAS) cases, 215 infectious pneumonia cases, and 60 other cases. The primary ultrasonic characteristic of TTN was pulmonary edema. “White lung” or a “compact B-line” were only observed in severe cases, whereas TTN primarily presented as pulmonary interstitial syndrome or “double lung point.” Furthermore, double lung point could appear during the recovery period of severe TTN or RDS, MAS, and pneumonia. Lung consolidation with air bronchograms was not observed in TTN patients. The results showed that white lung or a compact B-line exhibited a sensitivity of 33.8% and a specificity of 91.3% in diagnosing TTN, whereas double lung point exhibited a sensitivity of 45.6% and a specificity of 94.8% in diagnosing severe TTN.

Conclusions

Pulmonary edema, alveolar-interstitial syndrome, double lung point, white lung, and compact B-line are the primary ultrasound characteristics of TTN. Ultrasonic diagnosis of TTN based on these findings is accurate and reliable. TTN can be ruled out in the presence of lung consolidation with air bronchograms.

Section snippets

Study Subjects

The institutional review board of the Beijing Military General Hospital approved the study protocol (No. 2011-LC-Ped-01). This was a retrospective series study that included a total of 1,358 newborn infants hospitalized in the neonatal intensive care unit of the Bayi Children’s Hospital, affiliated with Beijing Military General Hospital, from January to December 2014 who underwent lung ultrasonography. All of the lung ultrasonography examinations were performed by one doctor, the clinical data

General Characteristics of the Study Population

At the time of hospital admission, according to the patients’ medical histories, clinical presentations, arterial blood gas analyses, chest radiographic examinations, and lung ultrasound findings, there were 412 patients without lung diseases (gestational age, 27+2 to 40+3 weeks; 228 male patients, 184 female patients; 255 delivered by vaginal delivery and 157 delivered by cesarean section; birth weight, 1,280-4,220 g) and 946 patients with various lung diseases (gestational age, 25+4 to

Discussion

Breathing difficulty is a common early neonatal critical illness that requires timely and appropriate treatment. Several common neonatal lung diseases can cause severe neonatal breathing difficulty, including TTN, RDS, pneumonia, pneumothorax, MAS, pulmonary hemorrhage, and congenital diaphragmatic hernia, among others. Among these conditions, TTN is the most common cause of neonatal dyspnea and accounts for approximately 33% to 50% of cases of neonatal breathing difficulty.10 Early, rapid, and

Acknowledgments

Author contributions: J. L. contributed to the study conception, ultrasound examination, data analysis, and writing and approval of the manuscript. X.-X. C., X.-W. L., and Y. W. contributed to clinical data analysis, manuscript preparation, and approval of the final manuscript. S.-W. C. and W. F. contributed to data collection, manuscript revision, and approval of the final manuscript.

Financial/nonfinancial disclosures: None declared.

Role of sponsors: The sponsor had no role in the design of

References (20)

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FUNDING/SUPPORT: This work was supported by the Clinical Research Special Fund of Wu Jieping Medical Foundation [320.6750.15072].

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