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Introduction of point-of-care neonatal lung ultrasound in a developing country


Despite neonatal lung ultrasound (LU) being diffused worldwide, its introduction in limited-resource areas has not been formally investigated. We conceived a project to introduce it in a level 3 NICU of a developing country and verify if, after a short protocolized training, clinicians may efficaciously use LU. Inter-rater agreement between ultrasound trainees and trainers was analyzed within both the local test and the diffusion phases of the project. High inter-rater agreements were found between expert trainers and the two neonatologists who were trained in a skilled European center (Cohen’s Kappa, 0.951; 95%CI, 0.882–0.999), as well as between the two and the second round of locally trained colleagues (Cohen’s Kappa, 0.896; 95%CI, 0.797–0.996). Moreover, a high agreement was found between the clinical respiratory diagnosis (used as the “gold standard”) and the LU diagnosis given by the first two trainees (intraclass correlation, 0.992; 95%CI, 0.987–0.996) and the locally trained physicians (intraclass correlation, 0.97; 95%CI, 0.95–0.98). A final survey demonstrated that the project was perceived as efficacious and that LU was going to be integrated into routine clinical practice.

Conclusions: А short LU training provided sufficient proficiency and allowed the LU introduction in clinical practice in the neonatal intensive care unit in a developing country.

What is Known:
Lung ultrasound is a promising technique for evaluating neonatal respiratory distress at least in high-income countries. Previous studies revealed high specificity and sensitivity in diagnosing specific neonatal disorders.
An important barrier to the more extensive use of lung ultrasound in neonatal critical care is a lack of efficient and suitable training solutions.
What is New:
Descriptive LU performed by neonatologist in a developing country after a short formal training is feasible with good quality.
A short formal LU training program provided good proficiency and allowed a correct descriptive diagnosis in a neonatal unit in a developing country.

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Fig. 1
Fig. 2



Acute respiratory distress syndrome


Lung ultrasound


Meconium aspiration syndrome


Neonatal intensive care unit


Respiratory distress syndrome


Transient tachypnea of the neonate


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Author information

PM organised the study in Armenia, interpreted findings and wrote the first manuscript draft; VK collected findings and helped in the interpretations; SSA and NY managed the whole first study phase and acted as teachers and interpreted the findings. DDL conceived the study, interpreted the data, performed the statistical analysis and supervised the whoel project. All authors critically review teh manuscript for important intellectual content and agreed on its final version.

Correspondence to P. Mazmanyan.

Ethics declarations

Local ethical committee approved this study (n.112), and written informed consent was obtained from parents upon NICU admission.

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The authors declare that they have no conflict of interest.

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Communicated by Patrick Van Reempts

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Mazmanyan, P., Kerobyan, V., Shankar-Aguilera, S. et al. Introduction of point-of-care neonatal lung ultrasound in a developing country. Eur J Pediatr (2020). https://doi.org/10.1007/s00431-020-03603-w

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  • Newborn
  • Lung ultrasound
  • Neonatal lung disease
  • Developing country