Lung ultrasound protocol decreases radiation in newborn population without side effects: A quality improvement project.

OBJECTIVE: To reduce radiation exposure in newborns admitted due respiratory distress based on the implementation of lung ultrasound (LUS). DESIGN: Quality improvement (QI), prospective, before-after, pilot study. SETTING: Third level neonatal intensive care unit (NICU) level with 25-bed and 1800 deliveries/year. PATIENTS: Inclusion criteria were neonates admitted with respiratory distress. INTERVENTIONS: After a theoretical and practical LUS training a new protocol was approved and introduced to the unit were LUS was the first-line image. To study the effect of the intervention we compare two 6-month periods: group 1, with the previous chest X-ray (CXR)-protocol (CXR as the first diagnostic technique) vs. group 2, once LUS-protocol had been implemented. MAIN VARIABLES OF INTEREST: The main QI measures were the total exposure to radiation. Secondary QI were to evaluate if the LUS protocol modified the clinical evolution as well as the frequency of complications. RESULTS: 122 patients were included. The number of CXR was inferior in group 2 (group 1: 2 CXR (IQR 1-3) vs. Group 2: 0 (IQR 0-1), p<0.001), as well as had lower median radiation per baby which received at least one CXR: 56 iGy (IQR 32-90) vs. 30 iGy (IQR 30-32), p<0.001. Respiratory support was similar in both groups, with lower duration of non-invasive mechanical ventilation and oxygen duration the second group (p<0.05). No differences regarding respiratory development complications, length of stay and mortality were found. CONCLUSIONS: The introduction of LUS protocol in unit decreases the exposure radiation in infants without side effects.

A new successful therapy for fetal chylothorax by intrapleural injection of maternal blood.

We present two cases of fetal chylothorax and hydrops diagnosed at 20 weeks' gestation, both of which underwent successful intrauterine treatment. In Case 1, a transient, near total resolution began 2 weeks after an iatrogenic hemothorax following a second thoracocentesis performed at 24 + 6 weeks. Because of pleural fluid reaccumulation, a Cesarean section was performed at 36 weeks. The 3805-g female neonate was admitted to neonatal intensive care but was discharged 50 days later in a healthy condition. In Case 2, resolution occurred after a third thoracocentesis and a second pleural injection of maternal blood, performed at 26 weeks. A 2660-g female neonate was delivered vaginally at 38 weeks. The infant remained asymptomatic and was discharged aged 4 days. Our experience suggests a possible useful role of intrapleural blood injection for the treatment of fetal chylothorax.