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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Acute respiratory distress syndrome
Meconium aspiration syndrome
Neonatal intensive care unit
Respiratory distress syndrome
Transient tachypnea of the neonate
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Local ethical committee approved this study (n.112), and written informed consent was obtained from parents upon NICU admission.
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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
- Lung ultrasound
- Neonatal lung disease
- Developing country