Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation

Abstract

The aims of the study are to investigate the possible role of ultrasound (US) of the chest in predicting the development of chronic lung disease (CLD) in patients with hyaline membrane disease (HMD) and to determine the optimal age for the sonographic examination. One hundred and five consecutive prematures undergoing mechanical ventilation were prospectively studied by US of the chest. The US examinations were performed at birth and at least once a week until discharge from the neonatal unit. The sonographic patterns observed behind the diaphragm and their evolutions were recorded and correlated with the clinical and radiological data at day 28, which corresponds to the currently accepted limit for determining the presence of CLD. CLD is currently defined as oxygen dependency on day 28 with radiographic abnormalities. A diffuse retrodiaphragmatic hyperechogenicity was observed in all the patients with HMD. The hyperechogenicity resolved completely in patients with an uncomplicated clinical evolution. In contrast, in patients with CLD the hyperechogenicity resolved only partially, resulting in less diffuse and less extensive hyperechogenicity. Day 18 was the earliest day where the persistence of the abnormal retrodiaphragmatic hyperechogenicity was observed in 100% of the patients presenting CLD at day 28. At that time, 95.2% of the patients without abnormal hyperechogenicity showed uncomplicated evolution and no CLD. US can be a useful diagnostic tool to determine the occurrence of CLD and to predict as early as day 18 the prematures at risk for the disease.

Lung Ultrasound in Respiratory Distress Syndrome: A Useful Tool for Early Diagnosis

“…A chest X-ray is necessary to confirm the diagnosis. Only a few studies have evaluated the potential of ultrasound for the diagnosis of RDS [3][4][5][6] , but all were performed with a transabdominal crosssection through the liver and the spleen, and all found that infants with RDS had increased echogenicity of the lung base.…”

“…Only a few studies have addressed this topic, and all of them utilized a transabdominal approach to evaluating lung echogenicity [3][4][5][6] . We previously described our ultrasonographic findings in the course of transient tachypnea of the newborn (TTN) [7] , showing that lung ultrasound may be a useful diagnostic tool in course of this disease.…”

The ‘Double Lung Point’: An Ultrasound Sign Diagnostic of Transient Tachypnea of the Newborn

“…In a few studies lung ultrasound also has been evaluated in newborns. Avni et al [18,19] and Pieper et al [20] used ultrasonography to diagnose hyaline membrane disease [18] and to predict the development of bronchopulmonary dysplasia [19,20] . These authors, however, utilized only an abdominal approach and ultrasound was not adopted as a routine method of assessing neonatal respiratory disorders.…”

Can Lung Ultrasound Scanning Be a Useful Diagnostic Tool in Neonates with Respiratory Distress?

“…Previous reports of lung ultrasound studies in the newborn suggest that they are diagnostic in RDS and predictive of bronchopulmonary dysplasia [4][5][6] . More important than diagnosing TTN, for which there is no specific treatment, lung ultrasound scanning in neonates may be useful to diagnose or rule out other disorders that may require immediate action.…”

“…For example, sensitivity and specificity in the range of 92-100% have been reported for pulmonary edema when compared with patients with chronic obstructive pulmonary disease. In neonates, lung ultrasound has been reported to be diagnostic in RDS [4][5][6] and predictive of bronchopulmonary dysplasia [5,6] . However, lung…”