International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Abstract

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Lungenultraschall in der Neonatologie zur Diagnostik eines Pneumothorax (Teil 2): Eine Praxisanleitung

“…Bei der Anwendung des LUS in der Neonatologie sticht besonders die ausgezeichnete Evidenz in der Diagnostik eines Pneumothorax heraus [3][4][5]. International wurden bereits lungensonografische Untersuchungsabläufe und -befunde beschrieben [6][7][8], allerdings gibt es aktuell im deutschsprachigen Raum noch keine Veröffentlichung zur Pneumothoraxdiagnostik mithilfe des Lungenultraschalls in der Neonatologie.…”

Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination

“…Each lung is divided into three areas:anterior,posterior,and lateral areas with the anterior and posterior axillary line as the boundaries.Therefore,the bilaterally lung is divided into six areas (that is six area division method) [20,21].Another approach is to additionally divide each side of the lung into upper and lower fields along the nipple connection and its extension line thus, the both lungs are divided into 12 regions (that is 12-area division method) [20,21].In this condition,the right/left (R/L) 1-6 zone marks are used to facilitate the lateral orientation.But in very low birth weight infants,it may be difficult to divide the lateral field into an upper and lower field,therefore, the subaxillary area is considered as one region,this is the 10 area division method [31,32] (Figure 4).…”

“…Transverse scanning is an essential supplement to longitudinal scanning.It is useful in the evaluation of small consolidations,particularly within the subpleural zone,as well as the grade I respiratory distress syndrome (Grade I RDS) which typically presented the ground-glass opacity signs on LUS [35].It is also easy to find the lung point, a specific sign of mild pneumothorax [20,21] (Figures 13-15, Supplementary avi 1) of moving the probe. ) showed only several B-lines,but when the probe was moved to the right axillary area for detection,it was found that there was typical atelectasis (Right 3-4) in this area.It was confirmed that the presence of atelectasis was the cause of the infant's dyspnea again.…”

“…To improve the popularization and promotion of the technology, some academic organizations have issued guidelines for neonatal LUS as a reference [20][21][22]. Despite these attempts, there is still a significant variation in clinical practice, specifically related to equipment settings, which are often influenced by different manufacture techniques and different settings.…”

Lungenultraschall in der Neonatologie zur Diagnostik eines Pneumothorax (Teil 1): Eine Evidenzanalyse – Zeit für einen neuen Goldstandard

“…Die bedeutendsten Ergebnisse wurden jedoch in der Pneumothoraxdiagnostik durch den Lungenultraschall erzielt [11,12]. Eine erste einheitliche Handlungsempfehlung zum Untersuchungsablauf eines LUS ist aktuell von internationalen Expert/innen auf dem Gebiet des POCUS veröffentlicht worden [13]…”