Parechovirus infection causing sepsis-like illness in newborns: a NICU approach.

Human parechovirus (HpeV) is an important emerging infection in young infants, able to cause sepsis-like disease and meningoencephalitis, especially in newborns. Among the 19 identified genotypes, HPeV1, 3 and 6 are the most common types involved in human infections; HPeV3 is the type mainly responsible for neonatal infections and for infections involving the central nervous system. Signs and symptoms overlap with those of a bacterial infection and patients are usually treated with broad spectrum antibiotics. In the majority of cases lumbar puncture shows absence of pleocytosis, even in the presence of signs of meningitis. In these cases, cerebrospinal fluid cultures are negative for bacteria but, in the absence of diagnosis of viral infection, a full and unnecessary antibiotic cycle is often continued. Moreover, high sensitivity neuroimaging, i.e., magnetic resonance, and follow-up are often missed, thus resulting in substandard care. Availability of a real time PCR assay for HPeV RNA allows rapid and sensitive diagnosis as long as the disease is suspected. In this case study, we present cases of HPeV infections in newborns requiring neonatal intensive care admission, discuss their optimal management, and highlight the most relevant findings in the literature.

Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax.

Background. Pneumothorax (PTX) still remains a common cause of morbidity in critically ill and ventilated neonates. At the present time, lung ultrasound (LUS) is not included in the diagnostic work-up of PTX in newborns despite of excellent evidence of reliability in adults. The aim of this study was to compare LUS, chest X-ray (CXR), and chest transillumination (CTR) for PTX diagnosis in a group of neonates in which the presence of air in the pleural space was confirmed. Methods. In a 36-month period, 49 neonates with respiratory distress were enrolled in the study. Twenty-three had PTX requiring aspiration or chest drainage (birth weight 2120 ± 1640 grams; gestational age = 36 ± 5 weeks), and 26 were suffering from respiratory distress without PTX (birth weight 2120 ± 1640 grams; gestational age = 34 ± 5 weeks). Both groups had done LUS, CTR, and CXR. Results. LUS was consistent with PTX in all 23 patients requiring chest aspiration. In this group, CXR did not detect PTX in one patient while CTR did not detect it in 3 patients. Sensitivity and specificity in diagnosing PTX were therefore 1 for LUS, 0.96 and 1 for CXR, and 0.87 and 0.96 for CTR. Conclusions. Our results confirm that also in newborns LUS is at least as accurate as CXR in the diagnosis of PTX while CTR has a lower accuracy.

Neonatal Lung Sonography: Interobserver Agreement Between Physician Interpreters With Varying Levels of Experience.

OBJECTIVES: To assess the reliability of lung sonography in neonates between physician interpreters with different degrees of experience. METHODS: We retrospectively reviewed lung sonograms from neonates admitted to a neonatal intensive care unit with respiratory distress in the first 24 hours of life. The first scans were selected; only patients with available video clips documenting both hemithoraxes were included. The clips were independently examined by 4 different experienced observers blinded to clinical data. The interpreting physicians made a codified sonographic diagnosis, and the Cohen κ coefficient was used to measure the reliability between a proven experienced main interpreter and expert (κ1), intermediate (κ2), and beginner (κ3) control interpreters. We also calculated the specific agreement on respiratory distress syndrome and transient tachypnea of the neonate. RESULTS: Four hundred sixty-five clips were taken from 114 neonates examined over a 16-month period. The patients' median gestational age (range) was 34 weeks (25-41 weeks), and the median birth weight (range) was 2085 g (608-4134 g). Eighty-eight percent of examinations were performed within 24 hours after birth. The overall κ coefficients (95% confidence intervals) were κ1 = 0.94 (0.88-1.00); κ2 = 0.72 (0.61-0.83); and κ3 = 0.81 (0.71-0.90). For respiratory distress syndrome, κ1 = 0.94 (0.87-1.00); κ2 = 0.90 (0.81-0.99); and κ3 = 0.87 (0.78-0.97). For transient tachypnea of the neonate, κ1 = 0.95 (0.89-1.00); κ2 = 0.76 (0.64-0.88); and κ3 = 0.81 (0.70-0.91). CONCLUSIONS: In neonates with early respiratory distress, lung sonography has high interobserver agreement even between interpreters with varying levels of experience.

Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn.

BACKGROUND: Lung ultrasound (LUS) is a promising technique for the diagnosis of neonatal respiratory diseases. Preliminary data has shown a good sensitivity and specificity of LUS in the diagnosis of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN). OBJECTIVE: The aim of this study was to calculate the sensitivity, specificity, and negative (NPV) and positive predictive value (PPV) of LUS for RDS and TTN, using an external reader blinded to the clinical condition. DESIGN AND METHODS: Neonates with respiratory distress had a LUS within 1 h of admission. Images were uploaded and sent to the external reader, who made the ultrasound diagnosis according to the appearance of the images. The final clinical diagnosis was made according to all the available data, except LUS data. Sensitivity, specificity, PPV, and NPV were calculated considering the final clinical diagnosis as the gold standard. RESULTS: Fifty-nine neonates were studied (mean gestational age: 33 ± 4 weeks, mean birth weight: 2,145 ± 757 g). Twenty-three infants had a final diagnosis of RDS and 30 of TTN. LUS showed a sensitivity of 95.6% and specificity of 94.4%, with a PPV of 91.6% and a NPV of 97.1% for RDS, and a sensitivity of 93.3% and specificity of 96.5% with a PPV of 96.5% and a NPV of 93.4% for TTN. CONCLUSIONS: LUS showed high sensitivity and specificity in diagnosing RDS and TTN.