Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care?

Abstract

A neonatal point-of-care ultrasound has multiple applications, but its use has been limited in neonatal intensive care units in the Unites States. An increasing body of evidence suggests that lung ultrasound performed by the neonatologist, at the bedside, is reliable and accurate in differentiating neonatal respiratory conditions, predicting morbidity, and guiding invasive interventions. Recent research has shown that a lung ultrasound can assist the clinician in accurately identifying and managing conditions such as respiratory distress syndrome, transient tachypnea of the newborn, and bronchopulmonary dysplasia. In this review, we discuss basic lung ultrasound terminology, evidence for applications of neonatal lung ultrasound, and its use as a diagnostic and predictive tool for common neonatal respiratory pathologies.

Keywords: lung ultrasound; neonatal respiratory pathologies; point-of-care ultrasound; respiratory failure.

Figure 1

Lung ultrasound artifacts. B-model normal lung (a) B-model respiratory distress syndrome (b).

Figure 2

Lung ultrasound in B-mode. (A) A-lines, reverberation artifact from pleural line (B) B-lines, reverberation artifact from interstitial edema; (C) acoustic shadowing from the ribs.

Figure 3

Lung sliding in M-mode. Very low birthweight infant with respiratory distress syndrome with normal lung sliding (seashore sign).

Figure 4

Large pleural effusion in B-mode. Large pleural effusion with septation and complete atelectasis of the lung.

Figure 5

Effusion vs complete atelectasis. Large effusion suspected on chest X-ray (a). B-mode demonstrating complete atelectasis of the left lung without large pleural effusion (b).

Figure 6

Severe RDS in B-mode. Compact B-lines (white lung), subpleural consolidation, thick and irregular pleural line.

Figure 7

Pulmonary hemorrhage in B-mode.