NT-PROBNP as a screening tool for low-risk patent ductus arteriousus: a follow-up validation study.

The purpose of the study is to test whether NT-proBNP serves as a screening tool for low-risk patent ductus arteriosus and safely avoids routine early echocardiography. This is a prospective observational study in preterm infants ≤32 weeks of gestational age. Infants with ≥5100 pg/ml (positive screening) at 48-72 hours of life received comprehensive echocardiography and were treated according to shunt severity. Infants with NT-proBNP below 5100 pg/ml (negative screening) were managed expectantly. The main outcome was need for ductus treatment within the first 7 days of life. One hundred twenty-five infants were included; 82 had a negative NT-proBNP screening and 43 had a positive NT-proBNP screening. No infant (0%) with a negative screening was treated for ductus while 26 (60.4%) with a positive screening were treated (p < 0.001). NT-proBNP avoided a 65.6% of routine echocardiograms. NT-proBNP had an excellent performance to predict PDA treatment (AUC = 0.967).Conclusion: NT-proBNP at 48-72 hours of life has an excellent performance to detect low risk and avoids unnecessary echocardiograms. This may contribute to optimize PDA management in terms of resource utilization.

Lung ultrasound score has better diagnostic ability than NT-proBNP to predict moderate-severe bronchopulmonary dysplasia.

The N-terminal end of B-type natriuretic peptide (NT-proBNP) and lung ultrasound (LUS) score have been proven to be adequate early biomarkers of bronchopulmonary dysplasia (BPD) in preterm infants. Our aim was to study if the predictive capacity of each one is increased by analyzing them together. We included infants born before 32 weeks with NT-proBNP and LUS scores on the first day of life (DOL) and on the 3rd, 7th, and 14th DOL and compared the diagnostic ability for moderate-severe BPD (msBPD) of each biomarker and in combination. We also compared them with a multivariate model of msBPD using only clinical variables. The sample size was 133 patients, and twenty-seven (20%) developed msBPD. The LUS score on the 7th DOL had better performance than NT-proBNP at the same moment: area under the receiver operating characteristic curve (AUC) 0.83 (0.75-0.89) versus 0.66 (0.56-0.75), p = 0.003, without differences in the rest of the times studied. These values did not increase when using the combination of both. A multivariate regression model that included only clinical variables (birth weight and invasive mechanical ventilation (IMV) at the 7th DOL) predicted msBPD with the same AUC as after the addition of any of these biomarkers, neither together. CONCLUSION: The LUS score is a better predictor of msBPD on the 7th DOL than NT-proBNP in preterm infants born before 32 weeks, although they have similar diagnostic accuracy on the 1st, 3rd, and 14th DOL. Neither of them, nor together, have a better AUC for msBPD than a clinical model with birthweight and the need for IMV at the 7th DOL. WHAT IS KNOWN: • NT-proBNP and LUS score are early predictors of moderate-severe bronchopulmonary dysplasia (msBPD). WHAT IS NEW: • The combination of both NT-proBNP and LUS score does not increase the predictive ability of each separately.

Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness.

OBJECTIVES: To assess whether respiratory variation in aortic blood flow peak velocity can predict preload responsiveness in mechanically ventilated and hemodynamically unstable neonates. DESIGN: Prospective observational diagnostic accuracy study. SETTING: Third-level neonatal ICU. PATIENTS: Hemodynamically unstable neonates under mechanical ventilation. INTERVENTIONS: Fluid challenge with 10 mL/kg of normal saline over 20 minutes. MEASUREMENTS AND MAIN RESULTS: Respiratory variation in aortic blood flow peak velocity and superior vena cava flow were measured at baseline (T0), immediately upon completion of the fluid infusion (T1), and at 1 hour after fluid administration (T2). Our main outcome was preload responsiveness which was defined as an increase in superior vena cava flow of at least 10% from T0 to T1. Forty-six infants with a median (interquartile range) gestational age of 30.5 weeks (28-36 wk) were included. Twenty-nine infants (63%) were fluid responders, and 17 (37%) were nonresponders Fluid responders had a higher baseline (T0) respiratory variation in aortic blood flow peak velocity than nonresponders (9% [8.2-10.8] vs 5.5% [3.7-6.6]; p < 0.001). Baseline respiratory variation in aortic blood flow peak velocity was correlated with the increase in superior vena cava flow from T0 to T1 (rho = 0.841; p < 0.001). The area under the receiver operating characteristic curve of respiratory variation in aortic blood flow peak velocity to predict preload responsiveness was 0.912 (95% CI, 0.82-1). A respiratory variation in aortic blood flow peak velocity cut-off point of 7.8% provided a 90% sensitivity (95% CI, 71-97), 88% specificity (95% CI, 62-98), 7.6 positive likelihood ratio (95% CI, 2-28), and 0.11 negative likelihood ratio (95% CI, 0.03-0.34) to predict preload responsiveness. CONCLUSIONS: Respiratory variation in aortic blood flow velocity may be useful to predict the immediate response to a fluid challenge in hemodynamically unstable neonates under mechanical ventilation. If our results are confirmed, this measurement could be used to guide safe and individualized fluid resuscitation in critically ill neonates.

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Neonates and Preterm Infants: A Prospective Observational Study.

INTRODUCTION: Percutaneous central venous catheter (CVC) insertion is a challenging procedure in neonates, especially in preterm infants. OBJECTIVE: This study aims to describe the technical success and safety profile of ultrasound (US)-guided brachiocephalic vein (BCV) cannulation in neonates. METHODS: Prospective observational study. Neonates admitted to the neonatal intensive care unit (NICU) in whom US-guided cannulation of the BCV was attempted were eligible. Outcomes included first attempt success rate, the overall success rate, the number of attempts, the cannulation time, immediate mechanical complications, catheter indwelling days, and late complications. RESULTS: A total of 40 procedures in 37 patients were included. Median weight and age at the time of cannulation were 1.85 kg (0.76-4.8) and 13 days (3-31), respectively. First attempt and overall success rates were 29 (72.5%) and 38 (95%), respectively. No major complications were observed. Catheter-associated infection rate was 2.4/1,000 catheter days. There were no difference in outcomes between low weight preterm infants (<1.5 kg) and the rest of the cohort. There was no linear relationship between weight at time of insertion and the number of puncture attempts (r = 0.250; p = 0.154) or cannulation time (r = 0.257; p = 0.142). CONCLUSION: US-guided cannulation of the BCV may be considered in acutely ill neonates, including small preterm infants, who need a large bore CVC.

Location of the Central Venous Catheter Tip With Bedside Ultrasound in Young Children: Can We Eliminate the Need for Chest Radiography?

OBJECTIVE: To compare the use of bedside ultrasound and chest radiography to verify central venous catheter tip positioning. DESIGN: Prospective observational study. SETTING: PICU of a university hospital. PATIENTS: Patients aged 0-14 who required a central venous catheter. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Central venous catheter tip location was confirmed by ultrasound and chest radiography. Central venous catheters were classified as intra-atrial or extra-atrial according to their positions in relation to the cavoatrial junction. Central venous catheters located outside the vena cava were considered malpositioned. The distance between the catheter tip and the cavoatrial junction was measured. The time elapsed from image capture to interpretation was recorded. Fifty-one central venous catheters in 40 patients were analyzed. Chest radiography and ultrasound results agreed 94% of the time (κ coefficient, 0.638; p < 0.001) in determining intra-atrial and extra-atrial locations and 92% of the time in determining the diagnosis of central venous catheter malposition (κ coefficient, 0.670; p < 0.001). Chest radiography indicated a greater distance between the central venous catheter tip and the cavoatrial junction than measured by ultrasound, with a mean difference of 0.38 cm (95% CI, +0.27, +0.48 cm). Three central venous catheters were classified as extra-atrial by chest radiography but as intra-atrial by ultrasound. To locate the central venous catheter tip, ultrasound required less time than chest radiography (22.96 min [20.43 min] vs 2.23 min [1.06 min]; p < 0.001). CONCLUSIONS: Bedside ultrasound showed a good agreement with chest radiography in detecting central venous catheter tip location and revealing incorrect positions. Ultrasound could be a preferable method for routine verification of central venous catheter tip and can contribute to increased patient safety.

Ultrasound evaluation of lumbar spine anatomy in newborn infants: implications for optimal performance of lumbar puncture.

An ultrasound evaluation of lumbar spine anatomic landmarks relevant for lumbar puncture was performed in 199 newborn infants. Effects of 6 patient positions and gestational age on interspinous process distance, subarachnoid space width, predicted needle entry angle, and needle insertion depth were assessed. Our results identify optimized conditions for lumbar puncture: sitting the infant with hips flexed, a needle entry angle of 65-70 degrees, and proper needle insertion depth (calculated as 2.5 × weight in kilograms + 6 in millimeters).

Lung Ultrasound Scores Progress Differently in Extreme and Very Preterm Infants after Birth: A Multicentre Prospective Study.

INTRODUCTION: The lung ultrasound score (LUS) has been suggested to predict moderate-severe bronchopulmonary dysplasia (msBPD) in preterm infants. We aimed to assess LUS evolution after birth in preterm infants and the effect of gestational age. METHODS: This multicentre prospective observational study was performed with newborns born before 33 weeks of gestation. We created two groups: group 1 (23-27 weeks) and group 2 (28-32 weeks). We compared LUSs between the groups from birth until 36 weeks of postmenstrual age, and we estimated the LUS evolution in each group with a linear multilevel mixed-effects regression model. The effects of the need for surfactant or an msBPD diagnosis were also studied. RESULTS: We included 339 patients: 122 (36%) in group 1 and 217 (64%) in group 2. The infants in group 1 showed a steady progression in the LUS from birth until 4 weeks of age and a subsequent decrease; the infants in group 2 showed a progressive decrease in the LUS throughout the study. This progression varied significantly in the first weeks of life in infants who required surfactant at birth and after the first week of life in the patients diagnosed with msBPD. DISCUSSION/CONCLUSIONS: Extremely preterm infants showed persistently high LUSs during the first weeks of life, regardless of the progression to msBPD. In this group, the infants who did not require surfactant at birth exhibited an increase in their LUSs after the first week until their values were equal to the remaining infants in their group.

Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study.

The objective of this study was to assess the predictive value of a lung ultrasound (LUS) score in the development of moderate-severe bronchopulmonary dysplasia (sBPD). This was a prospective  observational diagnostic accuracy study in a third-level neonatal intensive care unit. Preterm infants with a gestational age below 32 weeks were included. A LUS score (range 0-24 points) was calculated by assessing aeration semiquantitatively (0-3 points) in eight lung zones on the 7th day of life (DOL) and repeated on the 28th DOL. ROC curves and logistic regression were used for analysis. Forty-two preterm infants were included. The LUS on the 7th DOL had an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI: 0.87-1) for the prediction of sBPD (optimal cutoff of ≥8 points: sensitivity 93%, specificity 91%). The LUS score was independently associated with sBPD [OR 2.1 (95% CI: 1.1-3.9), p = 0.022, for each additional point in the score]. Conclusions: Lung aeration as assessed by LUS on the 7th DOL may predict the development of sBPD.

The Predictive Value of Lung Ultrasound Scores in Developing Bronchopulmonary Dysplasia: A Prospective Multicenter Diagnostic Accuracy Study.

BACKGROUND: Different lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous. RESEARCH QUESTIONS: What is the diagnostic accuracy of the LUS score to predict moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy? STUDY DESIGN AND METHODS: This was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point. RESULTS: Eight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve [AUC] 95% CI, 0.68-0.85 vs 0.68-0.85; P = .97), seventh DOL (AUC 95% CI, 0.74-0.85 vs 0.74-0.84; P = .26), and 21st DOL (AUC 95% CI, 0.72-0.86 vs 0.74-0.88; P = .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95% CI, 0.69-0.83 vs 0.66-0.80; P = .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95% CI, 0.77-0.88 vs 0.80-0.91 (P = .52). INTERPRETATION: The LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.

[Intrauterine restrictive foramen ovale: cause of neonatal pulmonary hypertension]. / Foramen oval restrictivo intraútero: causa de hipertensión pulmonar neonatal.

Premature closure of the foramen ovale (FO) or intrauterine restrictive FO is a rare entity of unknown etiology. This pathology is associated with an elevated risk of pulmonary hypertension, which can cause congestive heart failure with hydrops and fetal death. Patients with restrictive intrauterine FO may develop left ventricle diastolic dysfunction and pulmonary edema. A newborn with increased right cavities in the prenatal ultrasound is presented. In postnatal echocardiogram, dilatation of right cavities was confirmed with pulmonary hypertension in the systemic range and immobile interatrial septum with closed FO. After 9 days of persistent respiratory distress, an echocardiogram was performed with improvement of pulmonary hypertension but with mild biventricular and diastolic and systolic dysfunction of the left ventricle with pulmonary edema. Diuretic treatment was decided, with normalization of ventricular function.

El cierre prematuro del foramen oval o foramen oval restrictivo intraútero es una entidad rara de etiología desconocida. Dicha patología se asocia a un riesgo elevado de hipertensión pulmonar y puede ocasionar insuficiencia cardíaca congestiva con hidrops y muerte fetal. También, se puede asociar con disfunción diastólica en el período neonatal. Se presenta a un recién nacido en el que, en una ecografía prenatal, se visualizó un aumento de las cavidades derechas. En el ecocardiograma posnatal, se confirmó la dilatación de las cavidades derechas con hipertensión pulmonar en rango sistémico y septo interauricular inmóvil con foramen oval cerrado. A los 9 días, ante la persistencia de dificultad respiratoria, se realizó un ecocardiograma, con mejoría de la hipertensión pulmonar, pero con disfunción sistólica biventricular leve y diastólica del ventrículo izquierdo con edema pulmonar. Se indicó el tratamiento diurético, con normalización de la función ventricular.

N-terminal-probrain natriuretic peptide as a biomarker of moderate to severe bronchopulmonary dysplasia in preterm infants: A prospective observational study.

OBJECTIVE: N-terminal-probrain natriuretic peptide (NT-proBNP) is a marker of hemodynamically significant patent ductus arteriosus (HsPDA) in preterm infants. In this study, we assessed whether NT-proBNP levels could predict the risk of moderate to severe bronchopulmonary dysplasia (BPD) and/or death. METHODS: This was an observational prospective study of preterm infants with GA ≤32 weeks. Infants who died within the first 48 h or who had major congenital malformations or incomplete information were excluded. NT-proBNP was determined at 48-96 h of life and at 5-10 days of life. The predictive capacity of NT-proBNP for the combined outcome of BPD and/or death was evaluated using receiver operator characteristic (ROC) curves and multivariate regression. RESULTS: Of the 125 eligible patients, 110 completed the analysis. Twenty-eight developed BPD (n = 15) and/or died (n = 13). Infants who developed BPD and/or died had higher NT-proBNP levels ​​at 48-96 h (26,848 ng/L, interquartile range [IQR] 7818-60,684 vs 3008 ng/L, IQR 1425-9876) and at 5-10 days (8849 ng/L, IQR 3796-19,526 vs 1427 ng/L, IQR 907-2889). The NT-proBNP levels at 5-10 days, but not at 48-96 h, were independently associated with BPD and/or death after adjustments for HsPDA and other confounders (OR = 3.36; 95%CI: 1.52-7.4, P = 0.006). For the prediction of this result, a cutoff of 3348 ng/L had a sensitivity and specificity of 82% and 83%, respectively (area under the curve [AUC] = 0.87; 95%CI: 0.79-0.95). CONCLUSION: The NT-proBNP levels at 5-10 days of life may identify preterm infants with an HsPDA who are at high risk of BPD or death and may be useful for individualized preventive and therapeutic strategies.

[Impact of screening and treatment of low systemic blood flow in the prevention of severe intraventricular haemorrhage and/or death in pre-term infants]. / Impacto del cribado y tratamiento del bajo flujo sistémico en la prevención de hemorragia intraventricular grave y/o muerte en el prematuro.

OBJECTIVE: To assess the effect of a protocolised intervention for low systemic blood flow (SBF) in the occurrence of severe intraventricular haemorrhage (IVH) or death in pre-term infants. METHODS: A study with a quasi-experimental design with retrospective controls was conducted on pre-term infants of less than 30weeks of gestational age, born between January 2016 and July 2017, who were consecutively included in the intervention period. The control cohort included pre-term infants (born between January 2013 and December 2015) matched by gestational age, birth weight, and gender (two controls for each case). The cases of low SBF diagnosed according to functional echocardiography during the study period received dobutamine (5-10µg/kg/min) for 48hours. RESULTS: The study included 29 cases (intervention period) and 54 controls (pre-intervention period). Ten out of 29 (34.5%) infants received dobutamine for low SBF during the intervention period, with 3/29 (10.3%) cases of severe IVH and/or death compared to 17/54 (31.5%) in the control cohort (p=.032). There was an independent association between the intervention and a decreased occurrence of severe IVH/death after adjusting for confounding factors both in the logistic regression model [OR 0.11 (95%CI: 0.01-0.65), p=.015], as well as in the sensitivity analysis using inverse probability of treatment weighting [OR 0.23 (95%CI: 0.09-0.56); p=.001]. CONCLUSIONS: In this study with retrospective controls, a protocolised screening, and treatment for low SBF was associated with a decreased occurrence of severe IVH or death in preterm infants. Large, adequately powered trials, are needed in order to determine whether postnatal interventions directed at low SBF can improve neurological outcomes.

Utilidad de la ecografía pulmonar en el diagnóstico y seguimiento de la patología respiratoria neonatal / Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates

Objetivo: La ecografía pulmonar es una herramienta útil para el diagnóstico y seguimiento de la patología del paciente crítico neonatal. Su uso está cada vez más extendido gracias a sus ventajas sobre otras pruebas de imagen y el rápido incremento en la evidencia científica a su favor, constituyendo así, un pilar básico de las guías «point of care ultrasound» (POCUS) neonatal. El objetivo de este artículo especial es proporcionar las bases y aplicaciones diagnóstico-terapéuticas establecidas de la ecografía pulmonar, y dar a conocer nuevas aplicaciones. Métodos y resultados: La sección de ecografía pulmonar del Grupo de Trabajo de Ecografía Neonatal de la Sociedad Española de Neonatología resume la evidencia científica actual. Se describen los patrones ecográficos de las principales patologías respiratorias, aborda algunas de sus aplicaciones en la asistencia neonatal (predicción de ingreso, necesidad de surfactante, procedimientos ecoguiados, seguimiento del desarrollo pulmonar en el prematuro, entre otros) y propone su incorporación en otros escenarios actualmente menos establecidos como la reanimación o el manejo ventilatorio. Este artículo reafirma los beneficios de esta herramienta para ayudar en el diagnóstico, toma de decisiones terapéuticas, apoyo en procedimientos y valoración pronóstica. Conclusiones: La ecografía pulmonar debe establecerse como la prueba diagnóstica de elección en la patología respiratoria neonatal. Por ello, su entrenamiento debería formar parte de la formación de los neonatólogos e incluirse en los protocolos diagnóstico-terapéuticos asistenciales. Se deben seguir desarrollando líneas de investigación con estudios sólidos y multicéntricos que aumenten la calidad de la evidencia científica. (AU)

Objective: Lung ultrasound is a useful tool for diagnosis and follow-up of diseases in critically ill neonates. Its use is increasingly widespread thanks to its advantages over other imaging tests and the rapidly growing body of evidence to support it, and «point-of-care ultrasound» (POCUS) has become a key component in neonatal guidelines. The objective of this special article is to present the foundations and the established diagnostic and therapeutic applications of lung ultrasonography as well as introducing new applications. Methods and results: The Lung Ultrasound Section of the Neonatal Ultrasonography Working Group of the Spanish Neonatology Society has summarised the current scientific evidence. The article describes the sonographic features of the most common respiratory diseases, discusses some of the applications of ultrasound in neonatal care (such as prediction of admission and need of surfactant, ultrasound-guided procedures or monitoring of lung development in premature infants) and proposes its introduction in other scenarios in which its use is not quite established at present, such as resuscitation or respiratory management. This article reaffirms the usefulness of lung ultrasound in guiding diagnosis, clinical decision-making and prognosis and facilitating procedures. Conclusions: Lung ultrasound should be established as the gold standard for diagnosis of respiratory diseases in neonates. Therefore, training in lung ultrasound should be included in the educational curriculum of neonatologists and in diagnostic and therapeutic care protocols. Research on the subject should continue to be pursued with performance of rigorous multicentre studies to increase the quality of the evidence. (AU)

Comparison of ultrasound guided brachiocephalic and internal jugular vein cannulation in critically ill children.

PURPOSE: To determine whether ultrasound (US)-guided longitudinal in-plane supraclavicular cannulation of the brachiocephalic vein (BCV) improves cannulation success rates compared to transverse out-of-plane internal jugular vein (IJV) cannulation in urgent insertion of temporary central venous catheters (CVC) in critically ill children. MATERIALS AND METHODS: Prospective open pilot (non-randomized) comparative study carried out in a pediatric intensive care unit (PICU) of a university-affiliated hospital. Newborns and children aged 0 to 14 years admitted to the PICU in whom an urgent CVC was clinically indicated and was inserted in the IJV or BCV by US guidance were eligible. First-attempt success rate, overall success rate, number of puncture attempts, and cannulation time were compared between IJV and BCV techniques. RESULTS: Forty-six procedures (24 IJV and 22 BCV) in 38 patients were included. Full-sample median (range) age and weight were 13 (0.6-160) months and 9.5 (0.94-50) kg. No significant differences between IJV and BCV groups were observed for sex, age, weight, admission diagnosis, intra-procedural mechanical ventilation and sedation protocol. First attempt success rate was higher in the BCV than the IJV group (73 vs 37.5%, P= .017). Overall success rate was slightly higher in the BCV group (95 vs 83%, P = nonsignificant). Median (range) number of cannulation attempts [1 (1-3) vs 2 (1-4)] and cannulation time [66 (25-300) vs 170 (40-500) seconds] were significantly lower in the BCV group (P< .05). Patient's weight was inversely related to the number of cannulation attempts (Pearson coefficient -0.537, P= .007) and cannulation time (Pearson coefficient -0.495, P= .014) in the IJV but not in the BCV group. No major complications were observed. CONCLUSIONS: Ultrasound-guided supraclavicular in-plane BCV cannulation improved first attempt CVC cannulation success rates and reduced puncture attempts and cannulation time compared to US-guided out-of-plane IJV in critically ill children. A large randomized clinical trial is warranted to confirm our results.

[Ultrasound-guided cannulation of the brachiocephalic vein in neonates and infants]. / Canalización del tronco braquiocefálico guiada por ecografía en neonatos y lactantes.

INTRODUCTION: Central venous catheter (CVC) insertion in neonates and small infants is a challenging and high risk procedure. Ultrasound (US) guided cannulation increases the success rate and reduces procedural-related complications. The internal jugular vein is the most frequent site for US-guided CVC insertion. However this approach is technically demanding in neonates and small infants. US-guided supraclavicular cannulation of the brachiocephalic vein (BCV) is a new approach that may be advantageous in case of difficult central venous catheterization. We present our preliminary experience with this technique in a case series of neonates and small infants. METHODS: Case series of neonates and small infants weighing less than 5kg, in whom US-guided supraclavicular cannulation of the BCV was attempted. A longitudinal "in plane" supraclavicular approach to the BCV was performed using a 12Hz linear or a 8Hz microconvex transducer. All cannulations were performed by the same operator, a pediatrician with previous experience in US-guided central venous catheterization. RESULTS: The study included 6 patients with a median (range) weight of 2.1 (0.94-4.1) kg and age of 1.9 (0.6-4) months. Two cases required 2 punctures, while cannulation was achieved at the first attempt in the remaining 4 cases. There were no procedural or catheter-related complications. CVCs were withdrawn after 9 (6-15) days. CONCLUSIONS: The US-guided supraclavicular approach to the BCV is a feasible and safe alternative in neonates and very small infants. More studies are needed to define the role of this new venous access before its routine application in daily practice.

Ecografía a pie de cama en el diagnóstico precoz de la enterocolitis necrosante: una estrategia para mejorar el pronóstico / Bedside ultrasound in the early diagnosis of necrotising enterocolitis: A strategy to improve the prognosis

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