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Open AccessArticle

Monitoring of the Healthy Neonatal Transition Period with Serial Lung Ultrasound

by Po-Chih Lin, Chia-Huei Chen, Jui-Hsing Chang, Chun-Chih Peng, Wai-Tim Jim, Chia-Ying Lin, Chyong-Hsin Hsu and Hung-Yang Chang

Children 2023, 10(8), 1307; https://doi.org/10.3390/children10081307 - 29 Jul 2023

Cited by 1 | Viewed by 1227

Abstract

Ultrasound has been used to observe lung aeration and fluid clearance during the neonatal transition period, but there is no consensus regarding the optimal timing of lung ultrasound. We aimed to monitor the trend of the serial lung ultrasound score (LUS) and extended LUS (eLUS) throughout the neonatal transition period (≤1, 2, 4, 8, 24, and 48 h after birth), assess any correlation to the clinical presentation (using the Silverman Andersen Respiratory Severity Score (RSS)), and determine the optimal time of the ultrasound. We found both LUS and eLUS decreased significantly after 2 h of life and had similar statistical differences among the serial time points. Although both scores had a positive, moderate correlation to the RSS overall (Pearson correlation 0.499 [p < 0.001] between LUS and RSS, 0.504 [p < 0.001] between eLUS and RSS), the correlation was poor within 1 h of life (Pearson correlation 0.15 [p = 0.389] between LUS and RSS, 0.099 [p = 0.573] between eLUS and RSS). For better clinical correlation, the first lung ultrasound for the neonate may be performed at 2 h of life. Further research is warranted to explore the clinical value and limitations of earlier (≤1 h of life) lung ultrasound examinations. Full article

(This article belongs to the Section Pediatric Radiology)

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10 pages, 1009 KiB

Open AccessArticle

Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score

by Claudia Nussbaum, Maximilian Lengauer, Alexandra F. Puchwein-Schwepcke, Veronique B. N. Weiss, Benedikt Spielberger and Orsolya Genzel-Boroviczény

Children 2022, 9(9), 1292; https://doi.org/10.3390/children9091292 - 26 Aug 2022

Cited by 7 | Viewed by 5751

Abstract

The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing routine. We investigated the factors that steer the weaning process and whether the inclusion of the SAS would lead to more stringent weaning. Following SAS implementation, we prospectively evaluated 33 neonates born ≤ 32 + 0 weeks gestational age. Age-, weight- and sex-matched infants born before routine SAS evaluation served as historic control. In 173 of 575 patient days, NIV was not weaned despite little respiratory distress (SAS ≤ 2), mainly due to bradycardias (60% of days without weaning), occurring alone (40%) or in combination with other factors such as apnea/desaturations. In addition, “soft factors” that are harder to grasp impact on weaning decisions, whereas the SAS overall played a minor role. Consequently, ventilation times did not differ between the groups. In conclusion, NIV weaning is influenced by various factors that override the absence of respiratory distress limiting the predictive value of the SAS. An awareness of the factors that influence weaning decisions is important as prolonged use of NIV has been associated with adverse outcome. Guidelines are necessary to standardize NIV weaning practice. Full article

(This article belongs to the Special Issue Advances in Healthcare for Neonates)

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12 pages, 918 KiB

Open AccessArticle

Discriminant Analysis of Main Prognostic Factors Associated with Hemodynamically Significant PDA: Apgar Score, Silverman–Anderson Score, and NT-Pro-BNP Level

by Anna V. Permyakova, Artem Porodikov, Alex G. Kuchumov, Alexey Biyanov, Vagram Arutunyan, Evgeniy G. Furman and Yuriy S. Sinelnkov

J. Clin. Med. 2021, 10(16), 3729; https://doi.org/10.3390/jcm10163729 - 22 Aug 2021

Cited by 5 | Viewed by 4863

Abstract

Hemodynamically significant patent ductus arteriosus (hsPDA) in premature newborns is associated with a risk of PDA-related morbidities. Classification into risk groups may have a clinical utility in cases of suspected hsPDA to decrease the need for echocardiograms and unnecessary treatment. This prospective observational study included 99 premature newborns with extremely low body weight, who had an echocardiogram performed within the first three days of life. Discriminant analysis was utilized to find the best combination of prognostic factors for evaluation of hsPDA. We used binary logistic regression analysis to predict the relationship between parameters and hsPDA. The cohort’s mean and standard deviation gestational age was 27.6 ± 2.55 weeks, the mean birth weight was 1015 ± 274 g. Forty-six (46.4%) infants had a PDA with a mean diameter of 2.78 mm. Median NT-pro-BNP levels were 17,600 pg/mL for infants with a PDA and 2773 pg/mL in the non-hsPDA group. The combination of prognostic factors of hsPDA in newborns of extremely low body weight on the third day of life was determined: NT-pro-BNP, Apgar score, Silverman–Anderson score (Se = 82%, Sp = 88%). A cut-off value of NT-pro-BNP of more than 8500 pg/mL can predict hsPDA (Se = 84%, Sp = 86%). Full article

(This article belongs to the Special Issue Clinical Research into the Cardiovascular Health of People Born Preterm)

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