Tracheal intubation (TI) is a commonly done procedure in neonatal intensive care unit and delivery room during resuscitation. The confirmation of endotracheal tube (ETT) position should be done quickly as tube malposition is associated with various serious adverse outcomes like hypoxemia, right upper lobe collapse, atelectasis, air leak syndromes and esophageal intubation. ETT position can be confirmed by various methods like clinical sign, chest radiography, capnography, external digital tracheal palpation, ultrasonography (USG), respiratory function monitor, video-laryngoscope and fiberoptic devices. The current gold standard test to confirm ETT position is a chest radiograph, but it has many fallacies thus presently there is the need for a modality that helps in detection of endotracheal intubation and tube position with minimal complications. USG has been used in adult and pediatric population for detecting ETT position but there are very less studies in neonates. In this review, we analyze all the published studies, case reports and personal experiences that have sought the use of USG in neonatal population for detection of ETT position.
Central catheters are known as "life lines" in intensive care units and are used frequently in neonatal intensive care unit (NICU) for multiple indications. The central catheters used in NICU includes umbilical venous catheter (UVC), umbilical arterial catheter (UAC) and peripherally inserted central catheter (PICC) lines. The tip of these central lines needs to be in a correct position as malpositioned central line tips lead to many neonatal complications. Radiograph either abdomen or chest is the most widely used modality for locating the tip of the central catheter. There are many disadvantages of radiographic confirmation of tip position and recently ultrasound (USG)/echocardiography has been used for localization of catheter tip. USG provides real-time assessment of the tip position with other added advantages like no radiation exposure, need for minimal training for performing USG, minimal handling of the neonate, identification of migration of central lines and making repositioning of central lines under USG guidance. The present evidence supports the use of USG/Echo for localization of central catheter tip and USG has shown to have good sensitivity, specificity, positive predictive value and negative predictive value when compared with a radiograph. In this review, we discuss about the role of USG/Echo in the identification of tip of central catheters in neonatal care.
Asthma is the most common chronic illness in children and is a major reason for pediatric emergency department visits. Beta-2 agonists are considered the most effective drugs for immediate relief in the symptoms. This study aimed to compare the effectiveness of salbutamol delivered via jet nebulizer with a metered-dose inhaler (MDI) plus a spacer for asthma exacerbation in the pediatric emergency departments. The study was a randomized control, parallel-group design in children with age ranging from 6 months to 14 years, presenting in the emergency department with an acute asthma attack. A total of 116 patients were recruited for the study. Sixty-two patients were enrolled in the MDI/spacer group, and 54 patients were in the nebulizer group. Patients were assessed at baseline (0 min) and 15, 30, 45 and 60 min after commencement of the nebulizer and MDI/spacer. The response of each group to treatment was compared. The parents were counseled for their child enrolment in the study, which was approved by the Human Ethics Committee of Shahid Beheshti University of Medical Sciences. Ethic code was IR.SBMU.SM.REC.1394.19. The patients in both treatment groups demonstrated statistically noticeable improvement in clinical scores at all study assessment periods. Results revealed that salbutamol via MDI/spacer was as effective as salbutamol nebulization during the treatment of asthma exacerbations. Salbutamol MDI/spacer is equally efficacious when compared to nebulization. Therefore, because Salbutamol MDI/spacer is more user-friendly and affordable, it is preferable to be used in emergency departments.
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