Efficiency of Lung Ultrasonography in the Diagnosis and Follow-up of Viral Pneumonia in Newborn

Abstract

Objective Lung ultrasonography (LUS) is a useful method for diagnosis of lung diseases such as respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, and pneumothorax in the neonatal period. LUS has become an important tool in the diagnosis and follow-up of lung diseases. LUS is easy to apply at the bedside and is a practical and low-cost method for diagnosing pneumonia.

Study Design This study was conducted in neonatal intensive care unit of Dr. Sami Ulus Obstetrics, Children's Health and Diseases Training and Research Hospital. From September 2019 to April 2020, 50 patients who were diagnosed with viral pneumonia were included in the study. Also, 24 patients with sepsis-related respiratory failure were included in the study as a control group. LUS was performed at the bedside three times, by a single expert, once each before treatment for diagnosis, on discharge, and after discharge in outpatient clinic control.

Results Before treatment, LUS findings were lung consolidation with air bronchograms (50/50), pleural line abnormalities (35/50), B-pattern (25/50), disappearance of lung sliding (21/50), lung pulse (5/50), and pleural effusion (9/50). During discharge, we found significant changes: lung consolidation with air bronchograms (6/50), pleural line abnormalities (7/50), B-pattern (12/50), and pleural effusion (1/50) (p < 0.05). Outpatient clinic control LUS findings were lung consolidation with air bronchograms (0/50), pleural line abnormalities (0/50), B-pattern (0/50), disappearance of lung sliding (0/50), and pleural effusion (0/50) (p < 0.05). Also, B-pattern image, disappearance of lung sliding, and pleural line abnormalities were higher in control group (p < 0.05).

Conclusion Ultrasound gives no hazard, and the application of bedside ultrasonography is comfortable for the patients. Pneumonia is a serious infection in the neonatal period. Repeated chest radiography may be required depending on the clinical condition of the patient with pneumonia. This study focuses on adequacy of LUS in neonatal pneumonia.

Key Points

• Lung ultrasound is a practical and low-cost method in diagnosing pneumonia.

• Neonatal pneumonia is a very important cause of morbidity and mortality in NICU.

• We can evaluate neonatal pneumonia with combination of clinical presentations and LUS findings.

Keywords

lung ultrasound - viral pneumonia - newborn - diagnosis - follow-up

Publication History

Received: 07 December 2020

Accepted: 10 March 2021

Article published online:
27 May 2021

• References

• 1 Nissen MD. Congenital and neonatal pneumonia. Paediatr Respir Rev 2007; 8 (03) 195-203
• 2 Viscardi RM. Prenatal and postnatal microbial colonisation and respiratory outcome in preterm infants. In: Bancalari E, Polin R. eds. The Newborn Lung. 2nd ed.. Philadelphia, PA: Saunders; 2012: 135-162
• 3 Costa S, Rocha G, Leitão A, Guimarães H. Transient tachypnea of the newborn and congenital pneumonia: a comparative study. J Matern Fetal Neonatal Med 2012; 25 (07) 992-994
• 4 Sert A, Yazar A, Odabas D, Bilgin H. An unusual cause of fever in a neonate: influenza A (H1N1) virus pneumonia. Pediatr Pulmonol 2010; 45 (07) 734-736
• 5 Liu J. Lung ultrasonography for the diagnosis of neonatal lung disease. J Matern Fetal Neonatal Med 2014; 27 (08) 856-861
• 6 Hedstrom AB, Gove NE, Mayock DE, Batra M. Performance of the Silverman Andersen Respiratory Severity Score in predicting PCO₂ and respiratory support in newborns: a prospective cohort study. J Perinatol 2018; 38 (05) 505-511
• 7 De Luca D, van Kaam AH, Tingay DG. et al. The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity. Lancet Respir Med 2017; 5 (08) 657-666
• 8 Yousef N, De Luca D. The role of lung ultrasound in viral lower respiratory tract infections. Am J Perinatol 2018; 35 (06) 527-529
• 9 Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr 2015; 169 (08) e151797
• 10 Reissig A, Gramegna A, Aliberti S. The role of lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia. Eur J Intern Med 2012; 23 (05) 391-397
• 11 Lichtenstein DA, Mezière G, Lascols N. et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33 (06) 1231-1238
• 12 Kurepa D, Zaghloul N, Watkins L, Liu J. Neonatal lung ultrasound exam guidelines. J Perinatol 2018; 38 (01) 11-22
• 13 Liu J, Copetti R, Sorantin E. et al. Protocol and guidelines for point-of-care lung ultrasound in diagnosing neonatal pulmonary diseases based on international expert consensus. J Vis Exp 2019; (145) DOI: 10.3791/58990.
• 14 Liu J, Liu F, Liu Y, Wang HW, Feng ZC. Lung ultrasonography for the diagnosis of severe neonatal pneumonia. Chest 2014; 146 (02) 383-388
• 15 Volpicelli G, Silva F, Radeos M. Real-time lung ultrasound for the diagnosis of alveolar consolidation and interstitial syndrome in the emergency department. Eur J Emerg Med 2010; 17 (02) 63-72
• 16 Raimondi F, Cattarossi L, Copetti R. International perspectives: point-of-care chest ultrasound in the neonatal intensive care unit: an Italian perspective. Neoreviews 2014; 15 (01) e2-e6
• 17 Oktem A, Yigit S, Oğuz B, Celik T, Haliloğlu M, Yurdakok M. Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns. J Matern Fetal Neonatal Med 2019; 34 (02) 281-286
• 18 Caiulo VA, Gargani L, Caiulo S. et al. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol 2013; 48 (03) 280-287
• 19 Lichtenstein DA, Lascols N, Prin S, Mezière G. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med 2003; 29 (12) 2187-2192
• 20 Elia F, Verhovez A, Molino P, Ferrari G, Aprà F. Lung ultrasound in the reexpansion of pulmonary atelectasis. Intern Emerg Med 2011; 6 (05) 461-463
• 21 Volpicelli G. Lung sonography. J Ultrasound Med 2013; 32 (01) 165-171
• 22 Liu J, Cao HY, Wang XL, Xiao LJ. The significance and the necessity of routinely performing lung ultrasound in the neonatal intensive care units. J Matern Fetal Neonatal Med 2016; 29 (24) 4025-4030
• 23 Escourrou G, De Luca D. Lung ultrasound decreased radiation exposure in preterm infants in a neonatal intensive care unit. Acta Paediatr 2016; 105 (05) e237-e239
• 24 Liu J, Wang Y, Fu W, Yang C-S, Huang J-J. Diagnosis of neonatal transient tachypnea and its differentiation from respiratory distress syndrome using lung ultrasound. Medicine (Baltimore) 2014; 93 (27) e197
• 25 Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology 2008; 94 (01) 52-59