Delivery Room Lung Ultrasound-Feasibility, Normal Patterns, and Predictive Value for Respiratory Support in Term and Near-Term Neonates: A Monocentric Study.

AIM: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. MATERIALS AND METHODS: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. RESULTS: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001-delivery room; r = 4.0443, p < 0.001-one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). CONCLUSIONS: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support.

Early Intervention Guided by the General Movements Examination at Term Corrected Age-Short Term Outcomes.

BACKGROUND AND AIM: The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. MATERIALS AND METHODS: In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped-synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. RESULTS: Normal fidgety movements and a MOS-R of 20-24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. CONCLUSION: Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped-synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution.

Use of Lung Ultrasound in Reducing Radiation Exposure in Neonates with Respiratory Distress: A Quality Management Project.

Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm2 in 2021 to 3.76 Gy × cm2 in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases.

Foetal Intrapartum Compromise at Term: Could COVID-19 Infection Be Involved? A Case Report.

The impact of the SARS-CoV-2 infection on pregnancy has been studied and many reports have been published, mainly focussing on complications and in utero transmission with neonatal consequences. Although the effects of other viruses on foetuses are well known, the impact of maternal COVID-19 during pregnancy is not completely understood. We report a case of acute foetal intrapartum hypoxia without other risk factors than maternal COVID-19 disease 2 weeks previous to birth at term. Placental histological changes suggested that the viral infection could have been the culprit for the unfavourable outcome during labour. The neonate was promptly delivered by Caesarean section. Neonatal intensive care was started, including therapeutic hypothermia. The procedure was successful, the evolution of the neonate was favourable, and she was discharged after 10 days. Follow-up at 2 months of life indicated a normal neurological development but a drop in head growth. The case raises the idea that pregnancies with even mild COVID-19 symptoms may represent the cause of neonate compromise in a low-risk pregnancy. An important follow-up in the neonatal period and infancy is required to identify and treat any subsequent conditions. Further long-term studies are necessary to identify a cause-effect relationship between COVID-19 pregnancies and the whole spectrum of neonatal and infant consequences.

Correlations between Head Ultrasounds Performed at Term-Equivalent Age in Premature Neonates and General Movements Neurologic Examination Patterns.

BACKGROUND AND AIM: Our research aims to find correlations between the brain imaging performed at term-corrected age and the atypical general movement (GM) patterns noticed during the same visit a-cramped-synchronized (CS) or poor repertoire (PR)-in formerly premature neonates to provide evidence for the structures involved in the modulation of GM patterns that could be injured and result in the appearance of these patterns and further deficits. MATERIALS AND METHODS: A total of 44 preterm neonates ((mean GA, 33.59 weeks (+2.43 weeks)) were examined in the follow-up program at Life Memorial Hospital Bucharest at term-equivalent age (TEA). The GM and ultrasound examinations were performed by trained and certified specialists. Three GM pattens were noted (normal, PR, or CS), and the measurements of the following cerebral structures were conducted via head ultrasounds: ventricular index, the short and long axes of the lateral ventricles, the midbody distance of the lateral ventricle, the diagonal of the caudate nucleus, the width of the basal ganglia, the width of the interhemispheric fissure, the sinocortical width, the length and thickness of the callosal body, the anteroposterior diameter of the pons, the diameter of the vermis, and the transverse diameters of the cerebellum and vermis. The ultrasound measurements were compared between the groups in order to find statistically significant correlations by using the FANOVA test (significance p < 0.05). RESULTS: The presence of the CS movement pattern was significantly associated with an increased ventricular index (mean 11.36 vs. 8.90; p = 0.032), increased midbody distance of the lateral ventricle-CS versus PR (8.31 vs. 3.73; p = 0.001); CS versus normal (8.31 vs. 3.34; p = 0.001), increased long and short axes of the lateral ventricles (p < 0.001), and decreased width of the basal ganglia-CS versus PR (11.07 vs. 15.69; p = 0.001); CS versus normal pattern (11.07 vs. 15.15; p = 0.0010). The PR movement pattern was significantly associated with an increased value of the sinocortical width when compared to the CS pattern (p < 0.001) and a decreased anteroposterior diameter of the pons when compared to both the CS (12.06 vs. 16.83; p = 0.001) and normal (12.06 vs. 16.78; p = 0.001) patterns. The same correlations were present when the subgroup of infants with a GA ≤ 32 weeks was analyzed. CONCLUSIONS: Our study demonstrated that there are correlations between atypical GM patterns (cramped-synchronized-CS and poor repertoire-PR) and abnormalities in the dimensions of the structures measured via ultrasound at the term-equivalent age. The correlations could provide information about the structures that are affected and could lead to a lack of modulation in the GM patterns.

Respiratory Follow Up of the Premature Neonates-Rationale and Practical Issues.

The aim of the review was to present the state of knowledge about the respiratory pathology in former premature neonates (children that were born preterm-before 37 weeks of gestation-and are examined and evaluated after 40 weeks corrected age) other than chronic lung disease, in order to provide reasons for a respiratory follow-up program for this category of patients. After a search of the current evidence, we found that premature infants are prone to long-term respiratory consequences due to several reasons: development of the lung outside of the uterus, leading to dysmaturation of the structures, pulmonary pathology due to immaturity, infectious agents or mechanical ventilation and deficient control of breathing. The medium- to long-term respiratory consequences of being born before term are represented by an increased risk of respiratory infections (especially viral) during the first years of life, a risk of recurrent wheezing and asthma and a decrease in pulmonary volumes and airway flows. Late preterm infants have risks of pulmonary long-term consequences similar to other former premature infants. Due to all the above risks, premature neonates should be followed in an organized fashion, being examined at regular time intervals from discharge from the maternity hospital until adulthood-this could lead to an early detection of the risks and preventive therapies in order to improve their prognosis and assure a normal and productive life. The difficulties related to establishing such programs are represented by the insufficient standardization of the data gathering forms, clinical examinations and lung function tests, but it is our belief that if more premature infants are followed, the experience will allow standards to be established in these fields and the methods of data gathering and evaluation to be unified.

Significant Clinical Associations Between Exposure Type Factors and Recurrent Wheezing and Asthma in Children.

The study aimed to identify certain factors related to family history, pathological conditions, or exposure-type that are significantly correlated with recurrent wheezing and/or asthma in children. One hundred nine children with recurrent wheezing and 44 children with asthma were studied in order to identify the degree of correlation of these conditions with familial history of asthma or atopy, child's age group, gender, premature birth, perinatal asphyxia, neonatal infection, and antibiotic treatment during the neonatal period, history of atopy and obesity and histamine intolerance, nasopharyngeal bacterial colonization, pneumonia with bronchospasm. The clinical picture of these two diseases was also compared regarding the severity of exacerbations and their response to controller therapy. The medium age of children diagnosed with recurrent wheezing was significantly lower than those diagnosed with asthma (5.64 vs. 9.01 years; p<0.001). Inside the recurrent wheezing group, age distribution differed significantly from the asthma group (p-value <0.001). Atopy was the only pathological condition significantly associated with asthma (56.0%) when compared with the recurrent wheezing group (30.2%) with a relative risk value of 1.34 (p<0.004). For patients colonized with Staphylococcus aureus, the medium number of wheezing exacerbations was significantly higher (p<0.049). Approximately 91% of patients in the recurrent wheezing group and 71% from the asthma group responded to appropriate controller treatment. Our study showed a significant association between asthma and atopy, justifying the need to monitor asthma risk in a child with wheezing and atopy. Nasal carriage of Staphylococcus aureus proved to be significantly associated with the recurrence of wheezing in children.

Respiratory Outcome of the Former Premature Infants.

The research aims to identify the respiratory pathology during the first two years of life in premature infants with gestational ages between 30-34 weeks and the risk factors for these conditions (familial, prenatal, and neonatal). There were investigated 31 premature infants with gestational ages between 30-34 weeks and the incidence of bronchopulmonary dysplasia, infections with the respiratory syncytial virus, or other viral infections requiring hospitalization, recurrent wheezing, and nasal colonization with pathogenic bacteria were noted. Also, regression models for each type of respiratory pathology as a function of the antenatal (smoking in the family, atopy, mother's age) and neonatal (gestational age, respiratory distress syndrome, duration of the treatment with antibiotics, use of the reserve antibiotics) factors were elaborated. Respiratory distress syndrome was present in 20 premature infants, and 19 infants received respiratory support. Two former premature infants presented with bronchopulmonary dysplasia, 3 with severe respiratory syncytial virus infections, 7 with recurrent wheezing, and 16 with viral infections requiring hospitalization. Respiratory distress syndrome and severe viral infections were more frequently found in families of smokers. Low gestational age and familial atopy were identified as good predictors of severe respiratory syncytial virus infections (p< 0.03) Premature infants with gestational ages between 30-34 weeks present with the risk of appearance of respiratory diseases during the first two years of life, especially disorders of the airways. Familial atopy and low gestational age represent independent risk factors for severe respiratory syncytial virus infections.