Use of Neonatal Lung Ultrasound for the Early Detection of Pneumothorax

Abstract

Objective Pneumothorax (PTX) can be diagnosed using lung ultrasonography (LUS) in adult patients, but there are only a few reports of LUS in PTX diagnosis in neonates. The aim of the study was to assess the diagnostic accuracy for PTX.

Study Design This was a retrospective review study performed in our neonatal intensive care unit (level III) between June 2015 and June 2018. All eligible patients underwent an LUS scan before undergoing a chest X-ray (CXR), which was considered the reference standard. When a diagnosis of PTX was inconsistent between LUS and CXR, a chest computed tomography (CT) scan or chest drain was considered the gold standard.

Results Among 86 infants included in the study, 30 (34.9%) were diagnosed with PTX. In these 30 infants, 35 PTXs were detected by bedside LUS (five bilateral PTXs). Moreover, 11 infants with 14 PTXs were diagnosed only by LUS and were missed by CXR. Out of these 11 infants, 7 underwent a CT scan, whereas the remaining 4 underwent thoracentesis that confirmed PTX diagnosis.

Conclusion In neonates with PTX, LUS was more sensitive and specific for the early detection of PTX compared with CXR.

Keywords

pneumothorax - lung ultrasonography - neonate - diagnosis

^∗ These are co-first authors.

• References

• 1 Duong HH, Mirea L, Shah PS, Yang J, Lee SK, Sankaran K. Pneumothorax in neonates: trends, predictors and outcomes. J Neonatal Perinatal Med 2014; 7 (01) 29-38
• 2 Kliegman RM, Stanton BF, St Geme JW, Schor NF. , eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016: 865-866
• 3 Ball CG, Kirkpatrick AW, Laupland KB. , et al. Factors related to the failure of radiographic recognition of occult posttraumatic pneumothoraces. Am J Surg 2005; 189 (05) 541-546
• 4 Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care 2013; 17 (05) R208
• 5 Brook OR, Beck-Razi N, Abadi S. , et al. Sonographic detection of pneumothorax by radiology residents as part of extended focused assessment with sonography for trauma. J Ultrasound Med 2009; 28 (06) 749-755
• 6 Ianniello S, Di Giacomo V, Sessa B, Miele V. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med (Torino) 2014; 119 (09) 674-680
• 7 Raimondi F, Yousef N, Migliaro F, Capasso L, De Luca D. Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 2018; 2018: 1-5
• 8 Raimondi F, Rodriguez Fanjul J, Aversa S. , et al; Lung Ultrasound in the Crashing Infant (LUCI) Protocol Study Group. Lung ultrasound for diagnosing pneumothorax in the critically ill neonate. J Pediatr 2016; 175: 74-78.e1
• 9 Liu J, Chi JH, Ren XL. , et al. Lung ultrasonography to diagnose pneumothorax of the newborn. Am J Emerg Med 2017; 35 (09) 1298-1302
• 10 Liu DM, Forkheim K, Rowan K, Mawson JB, Kirkpatrick A, Nicolaou S. Utilization of ultrasound for the detection of pneumothorax in the neonatal special-care nursery. Pediatr Radiol 2003; 33 (12) 880-883
• 11 Lichtenstein DA, Mauriat P. Lung ultrasound in the critically ill neonate. Curr Pediatr Rev 2012; 8 (03) 217-223
• 12 Cattarossi L, Copetti R, Brusa G, Pintaldi S. Lung ultrasound diagnostic accuracy in neonatal pneumothorax. Can Respir J 2016; 2016: 6515069
• 13 Migliaro F, Sodano A, Capasso L, Raimondi F. Lung ultrasound-guided emergency pneumothorax needle aspiration in a very preterm infant. BMJ Case Rep 2014; 2014: 1-3
• 14 Chen L, Zhang Z. Bedside ultrasonography for diagnosis of pneumothorax. Quant Imaging Med Surg 2015; 5 (04) 618-623
• 15 Volpicelli G, Elbarbary M, Blaivas M. , et al; International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012; 38 (04) 577-591
• 16 Zhang M, Liu ZH, Yang JX. , et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care 2006; 10 (04) R112
• 17 Liu J. Lung ultrasonography for the diagnosis of neonatal lung disease. J Matern Fetal Neonatal Med 2014; 27 (08) 856-861
• 18 Vergine M, Copetti R, Brusa G, Cattarossi L. Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology 2014; 106 (02) 87-93
• 19 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
• 20 Liu J, Chen SW, Liu F, Li QP, Kong XY, Feng ZC. The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest 2015; 147 (04) 1013-1019
• 21 Liu J, Cao HY, Fu W. Lung ultrasonography to diagnose meconium aspiration syndrome of the newborn. J Int Med Res 2016; 44 (06) 1534-1542
• 22 Pieper CH, Smith J, Brand EJ. The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia. Pediatr Radiol 2004; 34 (03) 227-231
• 23 Lichtenstein DA, Mezière G, Lascols N. , et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33 (06) 1231-1238