Lung Ultrasound in Neonatal Diagnostic

Abstract

Neonatal respiratory disease is currently diagnosed on the basis of clinical signs and chest radiographs. It has been estimated that the average extremely low birth weight infant will have 31 radiographs taken from birth to NICU discharge (Wilson-Costello et al., Pediatrics 97(3):369–374, 1996). The relevance of this radiation exposure is still debated. Moreover, the interpretation of a chest radiograph has a significant interobserver variability. Ultrasound imaging of the lung has been traditionally neglected because the high acoustic impedance of its air content prevents a clear image of the organ. The pleura is the only lung structure clearly visible with ultrasounds appearing as a homogeneous, hyperechogenic line moving synchronous with respiration.

Adult emergency physicians have shown that the interpretation at the patient bedside of these findings together with some reproducible artifacts (see below) can be very useful in critical situations where echography outperforms conventional radiology (Lichtenstein, Ann Intensive Care 4(1):1, 2014; Lichtenstein, Chest 147(6):1659–1670, 2015).

It has to be remarked that the use of artifacts (i.e., images that do not correspond to any anatomical structure) has raised a lot of concern in the scientific community. Strict methodology and close correlation with clinical data have to be used when investigating with or practicing lung ultrasound.

On this line of thought, international, evidence-based recommendations have been published with age-related comments (Volpicelli et al., Intensive Care Med 38(4):577–591, 2012). Neonatologists have learned the lesson and are now applying point-of-care lung ultrasound to their practice (Rodríguez-Fanjul et al., Ann Pediatr (Barc), 2015; Yousef, Arch Pediatr. https://doi.org/10.1016/j.arcped.2015.12.001, 2016; Raimondi et al., Neoreviews 15(1):e2–e6, 2014). This chapter is a concise summary of their work.