Ultrasonographic evaluation of endotracheal tube position in newborns with CHD.

Many studies have been conducted to determine the most reliable technique for evaluating the position of the endotracheal tube in patients receiving mechanical ventilation support. In this study, we aimed to determine the endotracheal tube position by ultrasonography in intubated patients with a diagnosis of critical CHD followed in the neonatal ICU. METHODS: In this prospective observational clinical study, we performed point-of-care ultrasound for endotracheal tube localisation in 65 intubated newborns with critical CHD. After routine radiography, each patient underwent point-of-care ultrasound examination with a portable ultrasonography device for endotracheal tube end-carina measurement. Endotracheal tube end-carina measurements on chest radiographs were compared with ultrasound images. RESULTS: The mean gestational age and birth weight were 37.8 ± 2.19 weeks and 2888 ± 595 g, respectively. Ultrasound images were obtained after an average of 2.08 ± 1.6 hours from the radiographs. The average ultrasound time allocated to each patient was 5 minutes. The mean endotracheal tube tip-to-carina distance on chest X-ray and ultrasound were optimally 1.33 ± 0.64 cm and 1.43 ± 0.67 cm, respectively. There was no significant difference between chest X-ray and ultrasound measurements in endotracheal tube end-carina distance values evaluated by the Bland-Altman method (mean difference 0.10 cm, p = 0.068). There was a linear correlation between the endotracheal tube tip-carina distance in ultrasound and radiography evaluation (r2 = 0.60, p < 0.001). CONCLUSION: It has been concluded that critical CHDs are frequently accompanied by vascular anomalies, and the endotracheal tube tip-carina distance measurement can be used by determining the carina section as a guide point in the ultrasonographic evaluation of the endotracheal tube location in this patient population.

Massive upper gastrointestinal bleeding due to a gastric ulcer in a newborn.

Usually, swallowing of maternal blood is the cause of bloody vomiting in healthy term newborns. Other reported causes include gastritis, esophagitis, gastric ulcer, and duodenal ulcer. We report a newborn girl born by cesarean at 372/7 weeks who had hematemesis on postnatal day 1 and hematochezia on day 2. An erythrocyte transfusion was given on day 3. Gastroscopy performed on day 4 showed multiple gastric ulcers. Antacid treatment was given. On day 12, the newborn had a good general condition and stable vital signs and was discharged. Gastric ulcer needs to be considered as the etiology of hematemesis in healthy term newborns.