Format

Send to

Choose Destination
J Pediatr. 2016 Aug;175:74-78.e1. doi: 10.1016/j.jpeds.2016.04.018. Epub 2016 May 14.

Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate.

Author information

1
Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy. Electronic address: raimondi@unina.it.
2
Division of Neonatology, Hospital San Joan de Deú, Barcelona, Spain.
3
Division of Neonatology, Ospedali Civili, Brescia, Italy.
4
Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France.
5
Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy.
6
Division of Neonatology, Ospedale Rummo, Benevento, Italy.
7
Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy.
8
Division of Pediatric Diagnostics, Department of Biomorphological and Functional Sciences, Università "Federico II," Naples, Italy.

Abstract

OBJECTIVES:

To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient.

STUDY DESIGN:

In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation <65% for more than 40 seconds) and bradycardia or sudden increase of oxygen requirement by at least 50% in less than 10 minutes with a final fraction of inspired oxygen ≥0.7 to keep stable saturations. All eligible patients had an ultrasound scan before undergoing a chest radiograph, which was the reference standard.

RESULTS:

Forty-two infants (birth weight = 1531 ± 812 g; gestational age = 31 ± 3.5 weeks) were enrolled in 6 centers; pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases.

CONCLUSIONS:

Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage.

KEYWORDS:

lung ultrasound; neonate; pneumothorax

PMID:
27189678
DOI:
10.1016/j.jpeds.2016.04.018
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center