protocol-guidelines-for-point-care-lung-ultrasound-diagnosing

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

international-expert-consensus-recommendations-for-neonatal

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic ...

Cohen children's Medical Center

Considerable technological advances, good safety profile, and ease of use have converged to support the use of ultrasound (US) as an important adjunct in the evaluation of superficial soft tissue infections (SSTI) in general and the differential diagnosis of cellulitis and abscess in particular. However, its use in neonatal populations has not been described. Pediatric studies report clinical examination is not always a reliable method of distinguishing cellulitis from abscess. Two (2) case reports are presented to supplement the growing body of published data that describe US imaging of SSTIs. In both cases, the US exam included the affected area as well as contralateral or adjacent normal skin for comparison. Case 1 describes a preterm infant boy who required placement of a peripheral intravenous (PIV) line and subsequently developed warm, painful, erythematous, and indurated skin in the area of the insertion. Point-of-care US (POC-US) was used to diagnose cellulitis, which initiated treatment with intravenous antibiotics. Case 2 involves a 7-year-old boy with multiple comorbidities who developed a PIV extravasation-related injury that subsequently progressed to cellulitis, likely secondary to wound infection with methicillin-resistant Staphylococcus aureus. Both patients healed completely and without any complications. Because treatment of cellulitis is different from that of abscess, it is important to obtain real-time data supportive of an accurate diagnosis. In these cases, POC-US confirmed the clinical diagnosis of cellulitis and ruled out the presence of an abscess.

Point-Of-Care Ultrasound as an Adjunct in the Diagnosis of Neonatal and Pediatric Superficial Soft Tissue Infection: A Report of Two Cases.

Proper placement of endotracheal tube (ETT) in the midtrachea is essential. Initial depth of placement of oral ETT from the lips is commonly estimated based on weight ("7-8-9 rule"), gestational age, or nasal-tragus distance. However, these measurements can be altered by superficial factors and the mobility of the lips relative to the airway, so the upper alveolar ridge (gum) may provide a superior landmark. Also, confirmation of ETT tip position by point of care ultrasound (POC-US) is noninvasive and may enable localization of the ETT tip in real time. The objective of this study is to define optimal initial ETT depth from the gum in infants relative to weight, and to compare the efficacy of POC-US with standard chest x-ray (CXR) for confirming ETT tip position.

Determination of optimal endotracheal tube tip depth from the gum in neonates by X-ray and ultrasound.

The primary objective was to study agreement between X-rays and point of care ultrasound (POC-US) in determining central venous line (CVL) tip position. The secondary objective was to examine malposition rates over time using POC-US. Fifty-six neonates were enrolled who had a CVL placed. Initial X-rays and POC-US were obtained. POC-US was performed daily thereafter for the total of 6 days. US video clips were acquired in four standard echocardiographic views: subcostal, four-chamber, and short- and long-axis parasternal views. Gwet's agreement coefficient (AC1) for agreement measured inter-rater reliability of X-rays and POC-US (correct position/malposition). A generalized linear mixed model for binary clustered data estimated malposition rate over time. All analyses were conducted using SAS version 9.4 and Agree Stat. The study included 108 "pairs" of X-rays and POC-US images. Agreement coefficient (AC1), with respect to correct position/malposition of CVL tip, was high AC1 = 0.872 (UVC-AC1 = 0.814, PICC-AC1 = 0.94). Among birth weight (BW) < 1000 g, 1000-1499 g, and BW > 1500 g, AC1 values were 0.922, 0.774, and 0.873, respectively. CVL tip malposition rate decreased over time.Conclusions: Agreement between POC-US and X-rays for CVL tip position was high, with the highest in BW < 1000 g. The data suggest that POC-US can be used for initial confirmation and follow up of CVL tip position. What is Known • X-ray is currently the gold standard for localizing central venous line (CVL) tip position. • Malposition of CVL tip can lead to life-threatening complications. What is New • POC-US is superior to X-ray as it can follow CVL tip position over time, detecting malpositioned lines, adjusting them in a timely manner thus preventing complications. • Standardizing CVL placement, X-ray acquisition, POC-US acquisition with four views with video clips and ultrasound operator training increases accuracy and thus agreement between X-ray and POC-US. • UVC tip is more likely to be malpositoned than PICC tip. Malposition of UVC tip using POC-US decreased over time due to shrinking of the umbilical cord in the first 48 of life.

The superiority of point of care ultrasound in localizing central venous line tip position over time.

The primary aim of this study was to examine and describe peripheral intravenous extravasation (PIVE) injuries using point-of-care ultrasound (POC-US). A secondary aim was to define skin tissue changes before and after hyaluronidase application using POC-US.

Point-of-Care Ultrasound Use in Neonatal Peripheral Intravenous Extravasation Injuries: A Case Series.

The majority of extremely low gestational age neonates undergo intubation for surfactant therapy. Less invasive surfactant administration (LISA) uses a thin catheter inserted into the trachea to deliver the surfactant. During the procedure, the infant is breathing spontaneously while supported with continuous positive airway pressure. Although LISA is widely adapted in Europe and Australia, the rate of LISA use in the United States is unknown.

The use of less invasive surfactant administration (LISA) in the United States with review of the literature.

Chest X-ray (CXR) examination is a well-recognized imaging modality in the diagnosis of neonatal lung diseases. On the other hand, lung ultrasound (LUS) has been an emerging and increasingly studied modality. However, the role of LUS as well as its potential to replace CXRs in the detection of neonatal lung diseases has been debated. We combine the present research progress and our own clinical experience to elaborate on various aspects of the potential routine use of lung ultrasound in neonatal intensive care units. We conclude that both LUS and CXR have a number of advantages and disadvantages. They should serve as complementary diagnostic methods in providing accurate, timely, and reliable information.

ArticleTotal : 2	Year
Publication title Cited by 152	2019
Publication title Cited by 30	2020

Article	Year
Point-Of-Care Ultrasound as an Adjunct in the Diagnosis of Neonatal and Pediatric Superficial Soft Tissue Infection: A Report of Two Cases. Ostomy/wound management\| PubMed ID: 28759423	2017
Determination of optimal endotracheal tube tip depth from the gum in neonates by X-ray and ultrasound. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians\| PubMed ID: 30332898	2018
The superiority of point of care ultrasound in localizing central venous line tip position over time. European journal of pediatrics\| PubMed ID: 30374753	2019
Point-of-Care Ultrasound Use in Neonatal Peripheral Intravenous Extravasation Injuries: A Case Series. Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy and Continence Nurses Society\| PubMed ID: 30395125	2018
The use of less invasive surfactant administration (LISA) in the United States with review of the literature. Journal of perinatology : official journal of the California Perinatal Association\| PubMed ID: 30635595	2019
Neonatal lung diseases: lung ultrasound or chest x-ray. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians\| PubMed ID: 31220971	2019

Dalibor Kurepa

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