Diagnosis of pulmonary hemorrhage of the newborn infants using lung ultrasonography / 中华儿科杂志

Objective@#To investigate the accuracy and reliability of lung ultrasound in diagnosis of pulmonary hemorrhage of the newborn infants.@*Method@#From January 2014 to May 2016, 142 neonates from the Army General Hospital of the Chinese PLA were enrolled in the study. They were divided into two groups: a study group of 42 neonates, who were diagnosed with pulmonary hemorrhage according to their medical history, clinical manifestations and chest X-ray findings, and a control group of 100 neonates with no lung disease. All subjects underwent bedside lung ultrasound in a quiet state in a supine, lateral or prone posture, performed by a single experienced physician. The ultrasound findings were compared between the two groups.Fisher′s exact test was uesd for comparison between two groups.@*Result@#The lung ultrasound main findings associated with pulmonary hemorrhage included: (1) Shred sign: which was seen in 40 patients(95%). (2) Lung consolidation with air bronchograms: which were seen in 35 patients(83%). (3) Pleural effusion: which was seen in 34 infants(81%), pleurocentesis confirmed that the fluid was really bleeding.(4)Atelectasis: which was seen in 14 cases(33%). (5) Pleural line abnormalities and disappearing A-lines with an incidence of 100%. (6) Alveolar-interstitial syndrome: 5 patients(12%)had the main manifestations of alveolar-interstitial syndrome. The above signs were not seen in normal controls (all P<0.01) and the normal lung mainly manifested with clear pleural line and A-lines under ultrasound.@*Conclusion@#Lung ultrasonography is accurate and reliable for diagnosing pulmonary hemorrhage, which is suitable for routine application for the diagnosis of pulmonary hemorrhage in the neonatal intensive care unit.

Point-of-care examinations of lung ultrasonography in neonatal intensive care unit / 中华全科医师杂志

Objective To study the features of ultrasonography ( LUS) of lung diseases in neonatal intensive care unit ( NICU) .Methods Total 1413 neonates admitted in NICU of Beijing Chaoyang District Maternal and Child Health Hospital , Bayi Children′s Hospital Affiliated to the Chinese PLA General Hospital, Shenzhen Bao′an Maternal and Child Health Hospital from December 2014 to February 2015 were included in this study .All the newborns underwent LUS examination , the ultrasonographic features of neonatal lung diseases were analyzed .Results There were 1059 cases (74.9%) with lung diseases among 1413 neonates .Among 354 neonates without lung diseases , the B-lines were observed in 351 cases (99.2%) within 3 day after birth, in 113 cases (31.9%) in 3 day to 1 week after birth, and in 23 cases in 1 to 2 weeks after birth .Among 491 neonates with lung diseases undergoing LUS examination within 48 h after admission, the A-lines disappeared in all patients; the other features included pleural lines abnormalities (n=440, 89.6%), interstitial syndrome (n=353, 71.9%), lung consolidation(n=423, 86.25%), pulmonary edema ( n =135, 27.5%) and lung pulse ( n =96, 19.6%).The reduction or elimination of above abnormal signs represented the alleviation of lung diseases .Fifty four neonates , in whom the lung diseases were not detected by X-ray, were diagnosed as transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS)and pneumonia by LUS.Fifty five patients, who were misdiagnosed with RDS by X-ray, were confirmed as TTN by LUS .Seventy one neonatal patients with long-term oxygen dependence , in whom no abnormal signs were detected by X-ray, underwent LUS examination and lung atelectasis, pulmonary consolidation and/or interstitial syndrome were diagnosed in 46 cases.Conclusion The LUS is practical and effective in diagnosis of neonatal pulmonary diseases , it is a non-irradiative diagnostic procedure and can be applied on bed side;therefore, it should be routinely used in NICU .

Value of lung ultrasound on diagnosing transient tachypnea of newborn / 中华实用儿科临床杂志

Objective To evaluate the diagnostic value of lung ultrasonography for transient tachypnea of new-born (TTN).Methods From January to December 201 4,a total of 1 358 children were hospitalized in the Neonatal Intensive Care Center and underwent lung ultrasonography at the Bayi Children′s Hospital,Beijing Military General Hospital.According to the patients′medical histories,clinical presentations,arterial blood gas analysis,chest X -ray examinations,and lung ultrasound examinations,there were 41 2 cases of patients without pulmonary lesions,228 cases of TTN,358 cases of respiratory distress syndrome (RDS),85 cases of meconium aspiration syndrome (MAS),21 5 ca-ses of infectious pneumonia,and 60 other cases at the time of hospital admission.In a resting state,the patients were placed in a supine,lateral recumbent or prone position.By using the anterior and posterior axillary lines as boundaries, the lung was divided into 3 regions:anterior,lateral,and posterior.The probe was perpendicular or parallel to the ribs, and each region of both sides of the lung was scanned.The scan results were compared to the conventional chest X -ray results.Results The main ultrasonic characteristics of TTN was pulmonary edema.In severe cases,the ultrasound showed a white lung or compact B -line.Compact B -line had 1 00.0% sensitivity and 95.3% specificity for diagno-sing severe TTN.Mild TTN presented as pulmonary interstitial syndrome or double lung point.Double lung point might appear during the recovery period of mild TTN or other diseases,such as RDS,MAS,and pneumonia,among others. Lung consolidation and air bronchogram were not observed in patients with TTN.Pleural effusion might occur in a varie-ty of lung diseases,and pleural line abnormality,A -line disappearance,and B -line or pulmonary interstitial syndrome were common ultrasonic manifestations of a variety of lung diseases.Conclusions Ultrasonic diagnosis of TTN,mainly based on pulmonary edema without lung consolidation and air bronchogram,is accuracy and reliable;however,double lung point is not a specific sign of TTN,whereas the identification of a white lung and compact B -line is a sensitive and specific sign of severe TTN.

Lung ultrasonography for the diagnosis of meconium aspiration syndrome of the newborn infants / 中华实用儿科临床杂志

Objective To investigate the diagnostic value of lung ultrasonography for meconium aspiration syndrome (MAS).Methods From August 2014 to October 2015,a total of 67 cases of MAS patients were included in this study based on the medical history,typical clinical symptoms and chest X ray findings.The control group comprised 100 neonates without pulmonary disease.In a resting state,each patient was placed in a supine,lateral recumbent,or prone position.Using the anterior and posterior axillary lines as boundaries,each side of the lung was divided into 3 regions:anterior,lateral and posterior.The probe was held perpendicular or parallel to the ribs,and each region of both sides of the lung was scanned.Results In this study,the main lung ultrasonographic findings in MAS patients were as follows:(1) Lung consolidation with air bronchograms,which was found in all patients.Generally,the large area of lung consolidation with irregular margins was seen in severe MAS patients while the small area of lung consolidation was seen in mild patients.(2) Pleural line anomalies and the disappearance of the A-lines,which were found in all patients.(3) Atelectasis,which was found in 12 severe cases(17.9％),with severe massive atelectasis and visible lung pulse.(4) Pleural effusion,which was found in 9 cases (13.4％) including mild or severe patients.(5) Alveolar-interstitial syndrome (AIS) or B-line in the non-consolidation area was found in all patients.Conclusions There were specific imaging findings in lung ultrasound in MAS patients.Lung ultrasonography can be used for the routine diagnosis of MAS because of its accuracy,reliability,low-cost and simplicity,no risk of radiation damage as well as it is convenience to observe and understand the dynamic changes of the patients' condition timely.

Efficacy of noninvasive continuous positive airway pressure on infants with degree Ⅲ laryngeal obstruction / 中国小儿急救医学

Objective To explore the efficacy of noninvasive continuous positive airway pressure (nCPAP) on infants with degree Ⅲ laryngeal obstruction.Methods Sixty-two infants of acute laryngitis with degree Ⅲ laryngeal obstruction were divided into observation group (n =32) and control group (n =30),which were admitted to our PICU from Jan 2007 to Dec 2012.Thirty-two cases in the observation group were treated using the nCPAP.Thirty infants in the control group received regular mouth-nose mask oxygen therapy.The infants in both groups were given small-dose intravenous injection of methylprednisolone and inhalation of oxygen-driven nebulized epinephrine.Results In a hour after treatments,the effective rate in observation group was 100％,and the average duration for the treatments to take effect was (43.65 ±10.34) min.In control group,symptoms of 13 infants were improved within one hour (the effective rate was 43.3 ％),and symptoms of 22 infants were improved within two hours (the effective rate was 73.3 ％).The average duration for the treatments to take effect in control group was (73.70 ± 15.86) min.The differences of effective rates and take-effect duration between the two groups were statistically significant (P ＜ 0.01).After two hours' treatments,hypoxic symptoms of all infants in the observation group were obviously improved.The average heart rate[(172.24 ± 7.80) times per minute],the average oxygen saturation (90.16％ ±2.58％),the average arterial partial pressure of oxygen [(65.33 ±6.27) mm Hg],and the average partial pressure of carbon dioxide [(48.60 ± 4.39) mm Hg] were improved significantly compared with those before treatment [(146.39 ± 10.61) times per minute,98.53 ％ ± 0.42 ％,(93.64 ± 5.68) mm Hg,(44.25 ±5.76) mm Hg)].The differences were statistically significant (P ＜ 0.01).Conclusion The nCPAP auxiliary treatment is effective for infants with degree Ⅲ laryngeal obstruction,more effective than the regular oxygen therapy.

Pathogenic spectrum and bacterial resistance of severe community-acquired pneumonia / 中国小儿急救医学

Objective To study the distribution of pathogenic spectrum in children with severe community-acquired pneumonia(CAP) and bacteria antibiotic resistance.Methods One hundred and ninety-three children with severe CAP were enrolled from Mar 2011 to Feb 2012.Sputum specimens were collected for bacterial culture and drug sensitive test.Meanwhile mycoplasma pneumonia and chlamydia trachomatis were detected by fluorescent quantitative polymerase enzyme technology.Antigen of virus were detected by immunofluorescence assay.Results A total of 96 cases (49.7％) were bacteria positive in 193 children with severe CAP.The top four bacteria strains were klebsiella pneumoniae,staphylococcus aureus,escherichia coli and streptococcus pneumoniae.Most of gram-negative bacteria were resistant to ampicillin,cefazolin,ceftriaxone,ceftazidime,and compound sulfamethoxazole,but were sensitive to piperacillin/tazobactam,imipenem,ciprofloxacin,levofloxacin,amikacin.Gram-positive bacteria were resistant to penicillin and erythromycin,but sensitive to vancomycin.Fifty-three cases (27.5 ％,53/193) were virus Positive,81.1％ of which were less than 1 year old.Respiratory syncytial virus accounted for the most prevalent pathogen,followed by adenovirus,influenza virus A.Mycoplasma pneumoniae were positive in 4 patients (2.1％,4/193),chlamydia trachomatis were positive in 3 patients (1.6％,3/193).Mixed infection was found in 23 cases (11.9％,23/193).There were 14 cases (7.2％,14/193) with undetected pathogens.Conclusion Bacterium is the major pathogen in children with severe CAP and the virus is the second.The initial antibiotics administration of piperacillin/tazobactam or carbapenem and vancomycin should be chosen for severe bacteria pneumonia.

The expressions of neutrophil and lymphocyte CD11b in children with severe pneumonia / 中国小儿急救医学

Objective To investigate the significance of expressions of neutrophil and lymphocyte CD11b in children with severe pneumonia.Methods Expressions of neutrophils and lymphocytes CD11b were measured by flow cytometry in 36 children with severe pneumonia( severe pneumonia group),compared with 35 children with mild pneumonia ( mild pneumonia group) and 30 healthy children ( control group).Results In acute stage,expressions of neutrophil CD11b in severe pneumonia group and mild pneumonia group were (90.67 ± 7.03 ) ％ and ( 84.03 ± 5.08 ) ％,respectively,both of which were higher than that in control group [ ( 69.32 ± 5.72 ) ％ ] ( P ＜ 0.05 ).Furthermore,in acute stage,expression of neutrophils CD11b in severe pneumonia group was higher than that in mild pneumonia group (P ＜ 0.05 ).In recovery stage,expressions of neutrophil CD11b in children with severe pneumonia and mild pneumonia were(72.68 ±2.07 ) ％ and (71.45 ± 3.21 ) ％,respectively,which were both lower than those in acute stage ( P ＜ 0.05 ).In acute stage,expression of lymphocyte CD11b of children with severe pneumonia was ( 13.35 ± 6.52 )％,which was lower than that of mild pneumonia group [ ( 19.19 ± 6.47 ) ％ ] ( P ＜ 0.05 ),however,no significant difference was found between severe pneumonia group and control group [ ( 12.42 ± 6.43 ) ％ ] ( P ＞0.05).In recovery period,there was no significant difference in the expression of lymphocytes CD11b between severe pneumonia group [ ( 13.37 ± 4.88 ) ％ ] and mild pneumonia group [ ( 13.78 ± 4.53 ) ％ ] ( P ＞0.05).Conclusion Expressions of neutrophil and lymphocyte CD11 b participate in the pathogenesis of severe pneumonia.Detection of CD11b expression is helpful to diagnose severe pneumonia and predict the prognosis.