Incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates

Abstract

Introduction: Pneumothorax in neonates can be life-threatening. In neonates without respiratory distress, spontaneous pneumothorax can also develop under certain conditions.Objectives: To determine the incidence of ultrasonographic signs of pneumothorax in asymptomatic neonates using lung ultrasound as the diagnostic tool.Methods: This was an observational prospective study conducted at the Basurto University Hospital (Bilbao, Spain) between January 2018 and December 2020. Lung ultrasound was performed during routine examination of asymptomatic neonates admitted to the maternity ward.Results: Of a total of 204 asymptomatic neonates included in the study, 21 (10.3%) presented ultrasound signs of pneumothorax (Group A), and 183 (89.7%) had a normal lung ultrasound (Group B). Lung ultrasound was performed after a mean of 19 h of life (range 9-34). The presence of A-lines behind the sternum in the anterior transverse plane, at the intermammillary level, was observed in 100% of patients in Group A compared to no cases in Group B (p < 0.0001). The neonates of Group A presented the lung point located in the midclavicular line, indicative of a mild air leak.Conclusions: Lung ultrasound allows precise detection of suspected small-sized air leaks that can be detected in asymptomatic neonates. The true incidence of pneumothorax in asymptomatic neonates may be substantially higher than previously described in the literature.

Diagnostic Accuracy of Lung Ultrasound in Neonatal Diseases: A Systematized Review

“…Montero Gato et al [ 29 ] conducted an observational prospective investigation spanning from January 2018 to December 2020. During this period, lung ultrasound assessments were carried out as part of routine examinations of asymptomatic neonates admitted to the maternity ward.…”

“…We presented the results of a meta-analysis [ 28 ], which included relatively mature infants and heterogeneous studies and showed that LUS may be more convenient than CXR for PTX diagnosis, even if severe PTX is a limitation of the LUS technique. Two other studies were a prospective one [ 29 ], which showed that LUS may overdiagnose PTX in asymptomatic infants, and a retrospective study [ 30 ], in which the authors proposed the utility of specific LUS scans for the diagnosis of PTX. Hence, future studies are required to better understand the utility of LUS in different categories of infants (e.g., extremely preterm infants and term infants), with multiple scans, and in different clinical settings.…”