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Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation
E F Avni1, M Cassart, V de Maertelaer
1Department of Radiology, Erasme Hospital, Route de Lennik 808, B-1070 Brussels, Belgium.
Insights
Chest ultrasound (US) can predict chronic lung disease (CLD) in premature infants with hyaline membrane disease (HMD). Abnormal retrodiaphragmatic hyperechogenicity on day 18 indicates a high risk for developing CLD.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Medical Imaging
Background:
- Hyaline membrane disease (HMD) is a common respiratory distress in premature infants.
- Chronic lung disease (CLD) is a significant complication of HMD, requiring prolonged respiratory support.
- Early prediction of CLD is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To evaluate the utility of chest ultrasound (US) in predicting CLD development in premature infants with HMD.
- To determine the optimal timing for sonographic assessment to predict CLD.
- To correlate sonographic findings with clinical and radiological data for CLD diagnosis.
Main Methods:
- Prospective study of 105 premature infants undergoing mechanical ventilation.
- Chest US performed at birth and weekly until discharge.
- Sonographic patterns behind the diaphragm were recorded and analyzed.
- Correlation with clinical and radiological data at day 28 for CLD diagnosis.
Main Results:
- A diffuse retrodiaphragmatic hyperechogenicity was observed in all HMD patients.
- This hyperechogenicity resolved in uncomplicated cases but persisted partially in CLD patients.
- Persistence of abnormal hyperechogenicity on day 18 accurately predicted CLD at day 28 (100% sensitivity).
- Absence of abnormal hyperechogenicity on day 18 indicated uncomplicated evolution (95.2% specificity).
Conclusions:
- Chest ultrasound is a valuable tool for predicting CLD in premature infants with HMD.
- Sonographic assessment by day 18 can identify infants at risk for developing CLD.
- Early prediction allows for timely management strategies to mitigate CLD severity.
Abstract:
The aims of the study are to investigate the possible role of ultrasound (US) of the chest in predicting the development of chronic lung disease (CLD) in patients with hyaline membrane disease (HMD) and to determine the optimal age for the sonographic examination. One hundred and five consecutive prematures undergoing mechanical ventilation were prospectively studied by US of the chest. The US examinations were performed at birth and at least once a week until discharge from the neonatal unit. The sonographic patterns observed behind the diaphragm and their evolutions were recorded and correlated with the clinical and radiological data at day 28, which corresponds to the currently accepted limit for determining the presence of CLD. CLD is currently defined as oxygen dependency on day 28 with radiographic abnormalities. A diffuse retrodiaphragmatic hyperechogenicity was observed in all the patients with HMD. The hyperechogenicity resolved completely in patients with an uncomplicated clinical evolution. In contrast, in patients with CLD the hyperechogenicity resolved only partially, resulting in less diffuse and less extensive hyperechogenicity. Day 18 was the earliest day where the persistence of the abnormal retrodiaphragmatic hyperechogenicity was observed in 100% of the patients presenting CLD at day 28. At that time, 95.2% of the patients without abnormal hyperechogenicity showed uncomplicated evolution and no CLD. US can be a useful diagnostic tool to determine the occurrence of CLD and to predict as early as day 18 the prematures at risk for the disease.