Role of point of care lung ultrasound in neonatal respiratory distress in comparison with chest X-ray-a clinico-radiological evaluation

Authors

  • Manusha . Department of Paediatrics, School of Medical Sciences and Research Sharda University, Greater Noida, Uttar Pradesh, India
  • Shashi Bhushan Department of Paediatrics, School of Medical Sciences and Research Sharda University, Greater Noida, Uttar Pradesh, India
  • Satinder Aneja Department of Paediatrics, School of Medical Sciences and Research Sharda University, Greater Noida, Uttar Pradesh, India
  • Amit Gupta Department of Radiodiagnosis, School of Medical Sciences and Research Sharda University, Greater Noida, Uttar Pradesh, India
  • G. S. Sabhikhi Department of Radiodiagnosis, School of Medical Sciences and Research Sharda University, Greater Noida, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20222771

Keywords:

Point of care, Lung ultrasound, Respiratory distress, Chest X-ray

Abstract

Background: The use of ultrasound for immediate management of life-threatening conditions is one among the main changes of these last decades. Lung ultrasound has become more and more popular in the first decade of the 21st century, both in neonatal and in paediatric age groups. The lung ultrasound may be tool in differential diagnosis of respiratory distress in newborns. Aims and objectives: To assess diagnostic role of point of care lung ultrasound in neonates presented with respiratory distress and analyse the possibility of initiating management protocol based on lung ultrasound finding.

Methods: Present non-randomized study-a hospital based analytical cross-sectional study was carried out in 60 patients with respiratory distress for a period of 18 months (January 2020-30 June 2021). Neonates suffering from respiratory distress (Pulmonary cause with Downe’s score >4) were included.  Routine investigations, lung USG and chest x-ray examination was recorded. Detailed perinatal history were obtained.

Results: Mode of delivery was LSCS among 38.3% and vaginal delivery among 61.7% subjects. The mode of respiratory support was CPAP among 33.3% and ventilator among 66.7% subjects. Mean birth weight of the study population was 2003.51±767.35 grams. Final diagnosis of the present study shows that majority of neonates had respiratory distress syndrome (38.33%) followed by birth asphyxia with respiratory distress (28.33%) followed by TTNB (11.66%). A total of 25.0% neonates had Downes score 4, 16.7% had 5, 25.0% had 6, 26.7% had 7 and 6.7% neonates had 8 score. X-ray findings showed sensitivity 56.67% and positive predictive value 100% were observed. On the basis of USG findings, 93.22% sensitivity and positive predictive value 98.21% were observed.

Conclusions: Lung ultrasound is a non-invasive, bedside and repeatable method that could improve the management of neonatal respiratory distress. Neonatal lung ultrasound is a useful predictor of the need for intubation over chest x-ray. Combined lung consolidation, pleural line abnormalities and absence of A line findings were the most specific lung ultrasound findings in RDS which were present among majority of the patients.

References

Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev. 2013;14:29-36.

Hibbard JU, Wilkins I, Sun L, Gregory K, Haberman S, Hoffman M et al. Respiratory morbidity in late preterm births. Consortium on Safe Labor. JAMA. 2010;304:419-25.

Respiratory management. In: Gomella TL, Cunningham MD, Eyal FG. eds. Neonatology: Management, Procedures, On-Call Problems, Diseases, and Drugs. 7th ed. USA: Lange McGraw Hill Education LLC. 2013;71-89.

Pang H, Zhang B, Shi J, Zang J, Qiu L. Diagnostic value of lung ultrasound in evaluating the severity of neonatal respiratory distress syndrome. Eur J Radiol. 2019;116:186-91.

Koivisto M, Marttila R, Kurkinen-Räty M, Saarela T, Pokela ML, Jouppila P et al. Changing incidence and outcome of infants with respiratory distress syndrome in the 1990s: a population-based survey. Acta Paediatr. 2004;93:177-84.

Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R et al. European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants--2013 update. Neonatology. 2013;103:353-68.

Qian LL, Liu CQ, Guo YX, Jiang YJ, Ni LM, Xia SW et al. Chinese collaborative study group for neonatal respiratory diseases. Current status of neonatal acute respiratory disorders: a one-year prospective survey from a Chinese neonatal network. Chin Med J (Engl). 2010;123:2769-75.

Roberts CL, Badgery PT, Algert CS, Bowen JR, Nassar N. Trends in use of neonatal CPAP: a population-based study. BMC Pediatr. 2011;11:89.

Chavez MA, Shams N, Ellington LE, Naithani N, Gilman RH, Steinhoff MC et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50.

Karabinis A, Fragou M, Karakitsos D. Whole-body ultrasound in the intensive care unit: A new role for an aged technique. J Crit Care. 2010;25:509-13.

Liu J, Cao HY, Wang HW, Kong XY. The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr. 2015;25:e323.

Gupta V, Panigrahy N, Venkatlakshmi A, Chirla DK, Pandita A. Diagnostic ability of bedside lung Ultrasound in neonates with respiratory distress. J Pediatr Neonatal Care. 2018;8:308-12.

Zarei E, Alizadeh V. Comparing the results of chest x-ray with chest ultrasound in neonates admitted in neonatal intensive care unit. Indian J Neonat Med Res. 2018;6:19-23.

De Martino L, Yousef N, Ben-Ammar R, Raimondi F, Shankar-Aguilera S, De Luca D. Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics. 2018;142:e20180463.

Cattarossi L, Copetti R, Brusa G, Pintaldi S. Lung ultrasound diagnostic accuracy in neonatal pneumothorax. Can Respir J. 2016:6515069.

Liu J, Cao H, Wang H. The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Paediatr. 2014;24:147-54.

Pasic IS, Terzic S, Nisandzic J, Pokrajac D. Lung ultrasound and neonatal respiratory distress syndrome. J Clin Neonatol. 2020;9:272-5.

Raimondi F, Migliaro F, Sodano A, Ferrara T, Lama S, Vallone G et al. Use of neonatal chest ultrasound to predict noninvasive ventilation failure. Pediatrics. 2014;134:e1089-94.

Lichtenstein D. Lung ultrasound in the critically ill. Clin Intensive Care. 2005;16:79-87.

El-Masry HMA, Aladawy MA, Mansour TM, Hassan HA. Comparative study between chest x-ray and lung ultrasound in neonatal respiratory distress. Annals Neonat J. 2021;3:125-43.

Iovine E, Nenna R, Bloise S, La Regina DP, Pepino D, Petrarca L et al. Lung ultrasound: its findings and new applications in neonatology and pediatric diseases. Diagnostics (Basel). 2021;11:652.

Chen SW, Fu W, Liu J, Wang Y. Routine application of lung ultrasonography in the neonatal intensive care unit. Medicine (Baltimore). 2017;96:e5826.

Liu J, Cao HY, Fu W. Lung ultrasonography to diagnose meconium aspiration syndrome of the newborn. J Int Med Res. 2016;44:1534-42.

Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children. Radiol Med 2008;113:190-8.

Piastra M, Yousef N, Brat R, Manzoni P, Mokhtari M, De Luca D. Lung ultrasound findings in meconium aspiration syndrome. Early Hum Dev. 2014;90:41-3.

Downloads

Published

2022-10-27

Issue

Section

Original Research Articles