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.

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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Point-of-care ultrasound in the diagnosis of neonatal cerebral sinovenous thrombosis.

Cerebral sinovenous thrombosis (CSVT) mostly affects sick neonates in the neonatal intensive care unit (NICU) with predisposing or underlying conditions. The clinical presentation is nonspecific which often leads to a delayed or missed diagnosis. Point-of-care ultrasound (POCUS) use in the NICU is rapidly increasing. One of the main uses of neonatologist-performed POCUS is cranial ultrasound which permits diagnosis and monitoring of neurological disease at the bedside. We present the case of a neonate with a complex clinical situation where cranial POCUS permitted a prompt diagnosis and treatment of severe CSVT by imaging the transverse sinuses through the mastoid fontanelle.

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

OBJETIVO: Evaluar el efecto de un protocolo de cribado y tratamiento del bajo flujo sistémico (BFS) durante el periodo transicional en la aparición de hemorragia intraventricular (HIV) grave y/o muerte en prematuros. MÉTODOS: Estudio cuasi-experimental con controles retrospectivos. En la fase de intervención se incluyeron los prematuros de menos de 30semanas de edad gestacional (enero 2016-julio 2017). Los controles (enero de 2013-diciembre de 2015) fueron pareados por edad gestacional, peso al nacimiento y sexo con una relación 1:2. Los casos diagnosticados de BFS por ecocardiografía funcional durante el protocolo recibieron tratamiento con dobutamina (DB) entre 5-10 mig/kg/min durante 48 h. RESULTADOS: Se incluyeron 29 casos en la fase de intervención (aplicación del protocolo) y 54 controles (fase preintervención). Diez de 29 (34,5%) casos durante el protocolo recibieron DB por BFS con 3/29 (10,3%) casos de HIV grave y/o muerte comparado con 17/54 (31,5%) en la fase pre-protocolo (p = 0,032). El protocolo se asoció de forma independiente a una reducción en la HIV grave y/o muerte tanto en la regresión logística (OR: 0,11 (IC95%: 0,01-0,65), p = 0,015) como en el análisis de ponderación por la probabilidad inversa de tratamiento (OR: 0,23 (IC95%: 0,09-0,56); p = 0,001). CONCLUSIONES: En un estudio con controles retrospectivos, la aplicación de un protocolo de cribado y tratamiento del BFS en prematuros se asoció a una reducción en la HIV grave y/o muerte. Son necesarios ensayos clínicos de suficiente potencia para determinar si las intervenciones posnatales sobre el BFS pueden mejorar el pronóstico neurológico

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 30 weeks 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 (5-10 mig/kg/min) for 48 hours. 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

Paracetamol: tratamiento útil de elección para el ductus arterioso persistente en prematuros de muy bajo peso / Paracetamol: Useful treatment of choice for persistent arterial duct in very low weight premature newborns

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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.

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.