Lung ultrasound in Italian neonatal intensive care units: A national survey

Abstract

Introduction Lung ultrasound (LU) is a noninvasive, bedside imaging technique that is attracting growing interest in the evaluation of neonatal respiratory diseases. We conducted a nationwide survey of LU usage in Italian neonatal intensive care units (NICUs). Methods A structured questionnaire was developed and sent online to 114 Italian NICUs from June to September 2021. Results The response rate was 79%. In the past 4 years (range: 2–6), LU has been adopted in 82% of Italian NICUs. It is the first‐choice diagnostic test in 23% of the centers surveyed. The main LU diagnostic applications reported were: pneumothorax (95%), respiratory distress syndrome (89%), transient tachypnea of the newborn (89%), plural effusion (88%), atelectasis (66%), pneumonia (64%), bronchopulmonary dysplasia (43%), congenital pulmonary airway malformation (41%), and congenital diaphragmatic hernia (34%). Thirty percent of participating centers calculated LU score routinely, but only seven units used it to predict the need for surfactant replacement. Sixty‐six percent of respondents learned the LU technique via a self‐training process, while 34% of them visited an expert in the field for one‐to‐one tuition. Conclusions LU has a widespread use in Italian NICUs. However, the use of LU is extremely heterogeneous among centers. There is an urgent need to ensure standardization of clinical practice guidelines and to design and implement a formalized and accredited training program.

Neonatal point-of-care lung ultrasound: a UK-wide survey and the way forward

“…The learning curve for neonatal LU is such that gaining proficiency is possible for a range of grades of staff; however, robust accredited hands-on training is not in place to facilitate this. A recent survey of LU practice in Italian neonatal units highlights similar variation in its use and the need for training, although it is generally implemented more widely in their practice 5. The development of a national neonatal training curriculum appears to be the next step for safe implementation of neonatal LU.…”

Complications during mechanical ventilation—A pediatric intensive care perspective

“…More extensive discussion of POCUS techniques would be beyond the scope of this review, and readers are referred to a recent review by Bhoil et al (20). Pediatric specific literature supporting the use of POCUS in the pediatric ICU setting is steadily accumulating (21)(22)(23)(24), but concerns persist about its heterogeneous adoption between different pediatric and neonatal centers (22).…”

2022 Year in review: Neonatal pulmonology

“…Study outcome [1] Nationwide prospective cross-sectional survey LU in diagnosis of respiratory diseases: PTX (95%), RDS (89%), TTN (89%), PE (88%), Atelectasis (66%), Pneumonia (64%), BPD (43%), CPAM (41%), CDH (34%) [2] Review of literature LU patterns: type 1 (white lung), type 2 (prevalence of B lines), type 3 (predominance of A lines) LUS: 0: A-pattern (presence of only A-lines), 1: B-pattern (presence of 3 or more B-lines), 2: severe B-pattern (presence of crowded and coalescent B lines), 3: extended consolidation [3] Cross-sectional study Comparing POCUS to standard-of-care for ETT placement: POCUS was rapid and reliable [4] Retrospective cohort study Diagnosis of PTX: A-line in the anterior transverse plan was superior to mirrored ribs sign [5] Prospective study Evaluating lung recruitment: There was no difference in LUS between the first LU (LU-1) and LU-2, but there was an improvement in the oxygenation, RR, and CO 2 between LU-1 and LU-3.…”

“…In some papers, “nLUS” stands for neonatal lung ultrasound score. Corsini et al, 1 showed that 80% of neonatal LU is being done by neonatologists, based on a survey done in Italy. They also found that the top four diagnostic applications of LU were pneumothorax (PTX, 95%), RDS (89%), TTN (89%), and pleural effusion (88%).…”