Routine application of lung ultrasonography in the neonatal intensive care unit

Abstract

The aim of this study was to study the features of lung ultrasonography (LUS) in lung disease and to evaluate the usefulness of LUS in the neonatal intensive care unit (NICU).All of 3405 neonates included in this study underwent an LUS examination. Diagnoses were based on medical history, clinical manifestation, laboratory examination, and signs on chest radiography (CR) and/or computed tomography (CT). A single expert physician performed all LUS examinations.There were 2658 cases (78.9%) with lung disease and 747 cases (21.9%) without lung disease. The main signs of neonates with lung disease on LUS were as follows: absence of A-lines, pleural-line abnormalities, interstitial syndrome, lung consolidation, air bronchograms, pulmonary edema, and lung pulse. These abnormal signs were reduced or eliminated on LUS as patient conditions improved. There were 81 cases that could not be diagnosed as lung disease by CR but were discovered as pneumonia, respiratory distress syndrome (RDS), or transient tachypnea of newborn (TTN) on LUS. Likewise, 23 cases misdiagnosed as RDS by CR were diagnosed as TTN on LUS. Among 212 cases of long-term oxygen dependence (LTOD) that failed to yield signs of pulmonary edema and lung consolidation on CR, 103 cases showed abnormal signs on LUS. Among 747 cases without lung disease, B-lines of 713 neonates (95.4%) could be found within 3 days after birth, and 256 neonates (34.3%) could be observed from 3 days to 1 week after birth. B-lines of 19 cases could be detected from 1 to 2 weeks after birth. The longest time at which B-lines could still be observed was 19 days after birth.LUS has clinical value for the diagnosis of lung disease and the discrimination of causes of LTOP in premature infants, particularly for the diagnosis and identification of RDS and TTN. Moreover, LUS has additional advantages, including its lack of radiation exposure and its ability to noninvasively monitor treatment progress. Therefore, LUS should be routinely used in the NICU.

Figure 1

Flow diagram of ultrasonic examination. The features of all children enrolled in this study on lung ultrasonography.

Figure 2

Normal lung on lung ultrasonography (LUS). Smooth and clear pleura lines, parallel A-lines of normal lung on LUS.

Figure 3

Pneumonia on lung ultrasonography. Lung ultrasound findings of pneumonia in a neonate (gestational age, 36⁺² weeks; vaginal delivery; birth weight, 3010 g). Lung ultrasound showed pleura lines abnormalities, disappearance of A-line and lung sliding, irregular areas of lung consolidation with air bronchograms.

Figure 4

Respiratory distress syndrome (RDS) on lung ultrasonography. Lung ultrasound findings of RDS (grade III RDS on chest radiography) in a neonate (gestational age,33 weeks; cesarean section delivery; birth weight, 1915 g). Lung ultrasound showed pleural line abnormalities, disappearance of A-lines, subpleural lung consolidation with many air bronchograms, and pleural effusion.

Figure 5

Pulmonary atelectasis on lung ultrasonography. Lung ultrasound showed pleural line abnormalities, disappearance of A-lines, and rules large areas of atelectasis with hyperechogenic air bronchograms and hypoechogenic liquid bronchograms.

Figure 6

Transient tachypnea of newborn (TTN) on lung ultrasonography. Lung ultrasound findings of TTN in a neonate (gestational age, 36 weeks; virginal delivery; birth weight, 2510 g). Lung ultrasound showed pleural line abnormalities, disappearance of A-lines, and interstitial syndrome.

Figure 7

Meconium aspiration syndrome (MAS) on lung ultrasonography. Lung ultrasound findings of MAS in a neonate (gestational age, 41⁺³ weeks; cesarean section delivery; birth weight, 3756 g). Lung ultrasound showed pleural line abnormalities, disappearance of A-lines, lung consolidation with air bronchograms, and pleural effusion.