A Lung Ultrasound Severity Score Predicts Chronic Lung Disease in Preterm Infants

2019 ◽  
Vol 36 (13) ◽  
pp. 1357-1361 ◽  
Author(s):  
Mohamed Abdelmawla ◽  
Deepak Louis ◽  
Michael Narvey ◽  
Yasser Elsayed
Keyword(s):  
Lung Disease ◽  
Preterm Infants ◽  
Sensitivity And Specificity ◽  
Gestational Age ◽  
Chronic Lung Disease ◽  
Severity Score ◽  
Lung Ultrasound ◽  
Characteristic Curve ◽  
Preterm Neonates ◽  
Predictive Values

Objective To test the hypothesis that a lung ultrasound severity score (LUSsc) can predict the development of chronic lung disease (CLD) in preterm neonates. Study Design Preterm infants <30 weeks' gestational age were enrolled in this study. Lung ultrasound (LUS) was performed between 1 and 9 postnatal weeks. All ultrasound studies were done assessing three lung zones on each lung. Each zone was given a score between 0 and 3. A receiver operating characteristic curve was constructed to assess the ability of LUSsc to predict CLD. Results We studied 27 infants at a median (interquartile range [IQR]) gestational age and birth weight of 26 weeks (25–29) and 780 g (530–1,045), respectively. Median (IQR) postnatal age at the time of LUS studies was 5 (2–8) weeks. Fourteen infants who developed CLD underwent 34 studies. Thirteen infants without CLD underwent 30 studies. Those who developed CLD had a higher LUSsc than those who did not (median [IQR] of scores: 9 [6–12] vs. 3 [1–4], p < 0.0001). An LUSsc cutoff of 6 has a sensitivity and specificity of 76 and 97% and positive and negative predictive values of 95 and 82%, respectively. Adding gestational age < 27 weeks improved sensitivity and specificity to 86 and 98% and positive and negative predictive values to 97 and 88%. Conclusion LUSsc between 2 and 8 weeks can predict development of CLD in preterm neonates.

Antenatal Glucocorticoid Treatment Decreases Mortality and Chronic Lung Disease in Survivors among 23- to 28-Week Gestational Age Preterm Infants

2005 ◽  
Vol 22 (08) ◽  
pp. 441-448 ◽  
Author(s):  
José Figueras-Aloy ◽  
Manuel Moro Serrano ◽  
Jesús Pérez Rodríguez ◽  
Cristina Fernández Pérez ◽  
Vicente Roqués Serradilla ◽  
...  
Keyword(s):  
Lung Disease ◽  
Preterm Infants ◽  
Gestational Age ◽  
Chronic Lung Disease ◽  
Glucocorticoid Treatment

Antibody Response to Diphtheria-Tetanus-Pertussis Immunization in Preterm Infants Who Receive Dexamethasone for Chronic Lung Disease

PEDIATRICS ◽  
2004 ◽  
Vol 113 (4) ◽  
pp. 733-737 ◽  
Author(s):  
M. J. Robinson ◽  
C. Heal ◽  
E. Gardener ◽  
P. Powell ◽  
D. G. Sims
Keyword(s):  
Antibody Response ◽  
Lung Disease ◽  
Preterm Infants ◽  
Chronic Lung Disease

Breath-to-breath variability of exhaled CO2 as a marker of lung dysmaturity in infancy

2017 ◽  
Vol 123 (6) ◽  
pp. 1563-1570 ◽  
Author(s):  
Sotirios Fouzas ◽  
Ilias Theodorakopoulos ◽  
Edgar Delgado-Eckert ◽  
Philipp Latzin ◽  
Urs Frey
Keyword(s):  
Lung Disease ◽  
Preterm Infants ◽  
Chronic Lung Disease ◽  
Tidal Breathing ◽  
Term Infants ◽  
Young Infants ◽  
Postmenstrual Age ◽  
Preterm Group ◽  
Preterm Born ◽  
The Relationship

The concept of diffusional screening implies that breath-to-breath variations in CO2 clearance, when related to the variability of breathing, may contain information on the quality and utilization of the available alveolar surface. We explored the validity of the above hypothesis in a cohort of young infants of comparable postmenstrual age but born at different stages of lung maturity, namely, in term-born infants ( n = 128), preterm-born infants without chronic lung disease of infancy (CLDI; n = 53), and preterm infants with moderate/severe CLDI ( n = 87). Exhaled CO2 volume (VE,CO2) and concentration (FE,CO2) were determined by volumetric capnography, whereas their variance was assessed by linear and nonlinear variability metrics. The relationship between relative breath-to-breath change of VE,CO2 (ΔVE,CO2) and the corresponding change of tidal volume (ΔVT) was also analyzed. Nonlinear FE,CO2 variability was lower in CLDI compared with term and non-CLDI preterm group ( P < 0.001 for both comparisons). In CLDI infants, most of the VE,CO2 variability was attributed to the variability of VT ( r2 = 0.749), whereas in term and healthy preterm infants this relationship was weaker ( r2 = 0.507 and 0.630, respectively). The ΔVE,CO2 − ΔVT slope was less steep in the CLDI group (1.06 ± 0.07) compared with non-CLDI preterm (1.16 ± 0.07; P < 0.001) and term infants (1.20 ± 0.10; P < 0.001), suggesting that the more dysmature the infant lung, the less efficiently it eliminates CO2 under tidal breathing conditions. We conclude that the temporal variation of CO2 clearance may be related to the degree of lung dysmaturity in early infancy. NEW & NOTEWORTHY Young infants exhibit appreciable breath-to-breath CO2 variability that can be quantified by nonlinear variability metrics and may reflect the degree of lung dysmaturity. In infants with moderate/severe chronic lung disease of infancy (CLDI), the variability of the exhaled CO2 is mainly driven by the variability of breathing, whereas in term-born and healthy preterm infants this relationship is less strong. The slope of the relative CO2-to-volume change is less steep in CLDI infants, suggesting that dysmature lungs are less efficient in eliminating CO2 under tidal breathing conditions.

scholarly journals Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

2020 ◽  
Vol 180 (1) ◽  
pp. 137-146
Author(s):  
Nora Tusor ◽  
Angela De Cunto ◽  
Yousef Basma ◽  
John L. Klein ◽  
Virginie Meau-Petit
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Lung Pathology ◽  
Rater Agreement ◽  
X Ray ◽  
Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

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