Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications

Abstract

Lung ultrasound (LUS) is the latest amongst imaging techniques: it is a radiation-free, inexpensive, point-of-care tool that the clinician can use at the bedside. This review summarises the rapidly growing scientific evidence on LUS in neonatology, dividing it into descriptive and functional applications. We report the description of the main ultrasound features of neonatal respiratory disorders and functional applications of LUS aiming to help a clinical decision (such as surfactant administration, chest drainage etc). Amongst the functional applications, we propose SAFE (Sonographic Algorithm for liFe threatening Emergencies) as a standardised protocol for emergency functional LUS in critical neonates. SAFE has been funded by a specific grant issued by the European Society for Paediatric Research. Future potential development of LUS in neonatology might be linked to its quantitative evaluation: we also discuss available data and research directions using computer-aided diagnostic techniques. Finally, tools and opportunities to teach LUS and expand the research network are briefly presented.

Diagnostic value of lung ultrasound for neonatal respiratory distress syndrome: a meta-analysis and systematic review

“…In addition to the possible reasons discussed above, heterogeneity may be affected by variations in gestational age and operators [51] and may also depend on the probe that is used. Future studies should explore ways to reduce these variations, ensure repeatability of these results and identify the optimal probe needed for this purpose [54].…”

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

“…Similarly, the usefulness of LUS to diagnose PTX has been described in infants 19,20,21,22,23,24 . CT could not be used as the benchmark in neonatal patients, thus LUS was compared with chest X-ray and clinical exam findings.…”

“…For these reasons, in many neonatal intensive care units (NICUs), LUS is replacing chest X-rays in diagnosing PTX due to its superior sensitivity and specificity [15][16][17] . Moreover, LUS has been shown to be more accurate than chest X-rays even for small, non-tension PTX 18,19,20,21,22,23,24,25,26,27 . LUS signs of PTX were first studied and described in adult critical patients.…”

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

“…Intermediate situations may be obviously scored by averaging what the clinician sees on a scan (points 1, 2, and 3 of the Commentary), and more‐detailed scores may be validated . The author claims that the size of consolidations is not taken into account in the LUS score, although a threshold of 1 cm has been proposed to define substantial consolidations, and further studies are ongoing on this still‐open question . Interestingly, the author highlights the idea that an image may be made slightly different by moving the transducer and thus may be operator dependent.…”

“…Moreover, these signs must be searched for in a complete US scan and integrated with the imaging and clinical data to refine a respiratory diagnosis, and the use of a score does not prevent this integration . Finally, air leaks and effusions should be searched for when applying dedicated algorithms for emergency procedures such as the sonographic assessment of life‐threatening events (SAFE); for air leaks or effusion to be detected, the thorax must be bilaterally scanned, as suggested by the SAFE protocol. Thus, the author is contradicting himself, since he suggests not to do a complete bilateral US evaluation, which may clearly miss these and other signs (see below).…”