scholarly journals The Value of Lung Ultrasound Score Predicts the Ventilator use in Preterm with Dyspnea within 24h after Hospitalization

2022 ◽  
Author(s):  
lihua zhang ◽  
jinnan Feng ◽  
di jin ◽  
zekun yu ◽  
mingyang qu ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Sensitivity And Specificity ◽  
Area Under Curve ◽  
Lung Ultrasound ◽  
Respiratory Support ◽  
Good Reliability ◽  
Non Invasive ◽  
Mcnemar Test ◽  
Kappa Value ◽  
Ultrasound Score

Abstract This study aims to explore the predictive value of LUSsc(Lung Ultrasound Score) in the selection of respiratory support mode for premature infants with dyspnea.We prospectively included 857 preterm infants and performed LU in the first 2 hours of admission and scored LUSsc by two specialist sonographers. They were divided into two stratification according to gestational age (<32 +0 weeks and 32 +0 -36+6 weeks), and had two main outcomes: invasive and non-invasive respiratory support. In the training set, analysis the clinical factors finding the best cut-off value of lung ultrasound score then verified the consistency in the verification set. The choice of invasive respiratory support is based on neonatal mechanical ventilation rules. Preterm infants with invasive respiratory support had higher LUS scores and lower OI 、birth weight、than those with non-invasive support. For preterm <32 +0 weeks the cut-off point of LUSsc was 6.5 that the area under curve was 0.749 (95% CI: 0.689-0.809), which was statistically significant (P<0.05), and the sensitivity and specificity were 74.0% and 68.3%, for preterm 32 +0 -36 +6 weeks, cut-off point was 6.5 and the area under curve was 0.863 (95% CI: 0.811-0.911), sensitivity and specificity were 75.3% and 0.836%.In the validation set, use actual clinical respiratory support selection results to verify, for preterm <32 +0 weeks (Kappa value 0.660, P<0.05, McNemar test P ＞0.05),for preterm 32 +0 -36 +6 weeks (Kappa value 0.779, P<0.05, McNemar test P ＞0.05). Conclusion: The LUS score shows good reliability to predict respiratory support mode for preterm infants with dyspnea

Lung ultrasound score to monitor non-invasive respiratory support in hypoxemic patients

2019 ◽  
Author(s):  
Silvia Mongodi ◽  
Erminio Santangelo ◽  
Giulia Salve ◽  
Sandro Pregnolato ◽  
Silvia Bonaiti ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Respiratory Support ◽  
Non Invasive ◽  
Ultrasound Score

Automated control of oxygen titration in preterm infants on non-invasive respiratory support

2021 ◽  
pp. fetalneonatal-2020-321538
Author(s):  
Peter A Dargaville ◽  
Andrew P Marshall ◽  
Oliver J Ladlow ◽  
Charlotte Bannink ◽  
Rohan Jayakar ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Supplemental Oxygen ◽  
Respiratory Support ◽  
Target Range ◽  
Manual Control ◽  
Oxygen Control ◽  
Automated Control ◽  
Non Invasive ◽  
Automated Oxygen Control

ObjectiveTo evaluate the performance of a rapidly responsive adaptive algorithm (VDL1.1) for automated oxygen control in preterm infants with respiratory insufficiency.DesignInterventional cross-over study of a 24-hour period of automated oxygen control compared with aggregated data from two flanking periods of manual control (12 hours each).SettingNeonatal intensive care unit.ParticipantsPreterm infants receiving non-invasive respiratory support and supplemental oxygen; median birth gestation 27 weeks (IQR 26–28) and postnatal age 17 (12–23) days.InterventionAutomated oxygen titration with the VDL1.1 algorithm, with the incoming SpO2 signal derived from a standard oximetry probe, and the computed inspired oxygen concentration (FiO2) adjustments actuated by a motorised blender. The desired SpO2 range was 90%–94%, with bedside clinicians able to make corrective manual FiO2 adjustments at all times.Main outcome measuresTarget range (TR) time (SpO2 90%–94% or 90%–100% if in air), periods of SpO2 deviation, number of manual FiO2 adjustments and oxygen requirement were compared between automated and manual control periods.ResultsIn 60 cross-over studies in 35 infants, automated oxygen titration resulted in greater TR time (manual 58 (51–64)% vs automated 81 (72–85)%, p<0.001), less time at both extremes of oxygenation and considerably fewer prolonged hypoxaemic and hyperoxaemic episodes. The algorithm functioned effectively in every infant. Manual FiO2 adjustments were infrequent during automated control (0.11 adjustments/hour), and oxygen requirements were similar (manual 28 (25–32)% and automated 26 (24–32)%, p=0.13).ConclusionThe VDL1.1 algorithm was safe and effective in SpO2 targeting in preterm infants on non-invasive respiratory support.Trial registration numberACTRN12616000300471.

Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Victoria Aldecoa-Bilbao ◽  
Mar Velilla ◽  
Marta Teresa-Palacio ◽  
Carla Balcells Esponera ◽  
Ana Herranz Barbero ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Lung Ultrasound ◽  
Respiratory Support ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Pleural Line ◽  
Respiratory Management ◽  
Postmenstrual Age ◽  
Severity Of The Disease

<b><i>Introduction:</i></b> Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. <b><i>Methods:</i></b> Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. <b><i>Results:</i></b> Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (<i>p</i> &#x3c; 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted <i>NICHD 2001-BPD</i> with <i>R</i><sup>2</sup> = 0.522; AUC = 0.87 (0.79–0.94), <i>p</i> &#x3c; 0.001, and <i>Jensen 2019-BPD</i> with <i>R</i><sup>2</sup> = 0.315 (AUC = 0.80 [0.70–0.90], <i>p</i> &#x3c; 0.001). A model including mechanical ventilation &#x3e;5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (<i>R</i><sup>2</sup> = 0.655, <i>p</i> &#x3c; 0.001) with an AUC = 0.90 (0.84–0.97), <i>p</i> &#x3c; 0.001. <b><i>Conclusion:</i></b> LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

scholarly journals LUNG ULTRASOUND SCORE AND DIURETICS IN PRETERM INFANTS BORN BEFORE 32 WEEKS

2020 ◽  
Author(s):  
Almudena Alonso Ojembarrena ◽  
Alfonso Mar a Lechuga Sancho ◽  
Patricia Morales Arandojo ◽  
Silvia Acu as Soto ◽  
Rosa L pez de Francisco ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Lung Ultrasound ◽  
Ultrasound Score

scholarly journals Pharmacoepidemiology of Drug Exposure in Intubated and Non-Intubated Preterm Infants With Severe Bronchopulmonary Dysplasia

2021 ◽  
Vol 12 ◽  
Author(s):  
T. Lewis ◽  
W. Truog ◽  
L. Nelin ◽  
N. Napolitano ◽  
R. L. McKinney ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Drug Exposure ◽  
Respiratory Support ◽  
Rank Test ◽  
Multiple Drug ◽  
Continuous Variables ◽  
Short Acting ◽  
Non Invasive ◽  
Drug Classes

Background: Infants with severe bronchopulmonary dysplasia (BPD) are commonly treated with off-label drugs due to lack of approved therapies. To prioritize drugs for rigorous efficacy and safety testing, it is important to describe exposure patterns in this population.Objective: Our objective was to compare rates of drug exposure between preterm infants with severe bronchopulmonary dysplasia based on respiratory support status at or beyond 36 weeks post-menstrual age.Methods: A cross-sectional cohort study was performed on October 29, 2019. Preterm infants with severe BPD were eligible and details of respiratory support and drug therapy were recorded. Wilcoxon paired signed rank test was used to compare continuous variables between the invasive and non-invasive groups. Fisher’s exact test was used to compare binary variables by respiratory support status.Results: 187 infants were eligible for the study at 16 sites. Diuretics were the drug class that most subjects were receiving on the day of study comprising 54% of the entire cohort, followed by inhaled steroids (47%) and short-acting bronchodilators (42%). Infants who were invasively ventilated (verses on non-invasive support) were significantly more likely to be receiving diuretics (p 0.013), short-acting bronchodilators (p &lt; 0.01), long-acting bronchodilators (p &lt; 0.01), systemic steroids (p &lt; 0.01), systemic pulmonary hypertension drugs (p &lt; 0.01), and inhaled nitric oxide (p &lt; 0.01).Conclusion: Infant with severe BPD, especially those who remain on invasive ventilation at 36 weeks, are routinely exposed to multiple drug classes despite insufficient pharmacokinetic, safety, and efficacy evaluations. This study helps prioritize sub-populations, drugs and drug classes for future study.

14 Diaphragmatic Electrical Activity in Preterm Infants on Non-Invasive High Frequency Oscillatory Ventilation (DEAP-NHFO Study)

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e9-e10
Author(s):  
Jonathan Wong ◽  
Soonsawad Sasivimon ◽  
Rawan Abu Omar ◽  
Michael Dunn ◽  
Eugene Ng ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Electrical Activity ◽  
Preterm Infants ◽  
High Frequency ◽  
Respiratory Support ◽  
Respiratory Pattern ◽  
High Frequency Ventilation ◽  
Respiratory Drive ◽  
General Sequence ◽  
Non Invasive

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Continuous Positive Airway Pressure (CPAP) is a common form of non-invasive respiratory support for preterm infants. Non-invasive high frequency ventilation (NHFOV) is a relatively new method of non-invasive respiratory support. NHFOV is being increasingly utilized in clinical practice in an attempt to prevent intubation and minimize ventilator-induced lung injury in preterm infants. Preliminary studies suggest superiority of NHFOV over CPAP, but little is known about its mechanism of action and its effect on respiratory control in the newborn. We hypothesize that NHFOV reduces respiratory drive and improves ventilation, resulting in decreased patient diaphragm energy expenditure, which can be assessed by measuring the electrical activity of the diaphragm (Edi). Objectives The objective of this study is to compare the effects of non-invasive respiratory support delivered by nasal CPAP versus NHFOV on respiratory pattern, as assessed by the Edi in very low birth weight (VLBW) preterm infants. Design/Methods In a prospective, randomized, crossover study, 20 preterm infants with birth weights ≤1500 g requiring CPAP were randomized to either NHFOV or CPAP for 105 min, followed by crossover to the other method for the same duration. Edi was continuously measured by a feeding catheter with miniaturized sensors embedded in its wall (Maquet, Solna). The general sequence was 15 minutes for acclimation to the mode, 75 minutes for a feed to be completed, followed by 15 minutes for breath-by-breath analyses of neural breathing pattern. Primary outcome was difference in the peak Edi between CPAP and NHFOV. Secondary outcomes included difference in other measures of respiratory drive: neural respiratory rate, neural inspiratory time, diaphragm energy expenditure, transcutaneous pCO2, number of apnea episodes on the Edi, and episodes of clinically significant apnea. Results No significant differences in Edi timing, Edi min, Edi peak, apnea, or CO2 were observed between the two modes of respiratory support. Conclusion In this cohort of VLBW preterm infants, neural respiratory pattern was not significantly different between NHFOV and CPAP. With this baseline information in stable preterm infants, it would now be important to assess whether these results hold true in infants with more severe lung disease, where NHFOV is often used as escalating support from CPAP.

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.

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