Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport.

ABSTRACT

PURPOSE: Lung ultrasound (LUS) at the point-of-care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. METHODS: LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X-ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. RESULTS: LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI 70.5-98.5%), and specificity was 92.6% (95%CI 74.2-98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI 47.0-85.9%) and 81.5% (95%CI 61.2-92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI 36.5-99.1%) and a specificity of 100% (95%CI 89.9-100%). For CXR, sensitivity was 16.7% (95%CI 0.01-63.5%) and specificity was 97.7% (95%CI 86.4-99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI 0.40-0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI 0.74-0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. CONCLUSION: LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.