Dear all

Lung echography is having more and more importance thanks to its pecularities (simple, repeatable, no X ray exposition to the newborn, small time to achieve data), and thaks to its information about newborn disease (TTN vs RDS, PNX). What is your experience?

I agree it will be safer and reduce exposure to radiation for neonates and staff too 

there is interesting link 

http://www.criticalecho.com/content/tutorial-9-lung-ultrasound

Thanks a lot for that very interesting link. It will be very useful in the practice.

If you are advanced in sonoography, all you need is to print yourself pictures of artefacts, and try to do USG examination. I use usualy linear probe 5-12 MHz with settings for thyroid gland. If you are beginer it may be moore difficult, but it really is very easy exam. I like it very much. In my unit we almost don't do Xrays this days. We check our preemies during wentilation  every day, secon day or third day - depends from patient's condition, Even my nurses know the pictures now, and it help them in making decisions about changing positions, physiotherapy and so on. Practical considerations: in pneumonia usually in first exam it looks better than child shows in Siverman scale. Exam have to be repeated next day, and next day. It will progress even during ATB treatment. Very often we see consolidations and brochograms 2-3 days longer after patient's clinical improvement is seen. Usually it correlates with pO2 wchich is slightly lower than it should be. In RDS you will see white lungs - many, many B artefakts wchich are marks of "wet lung". In TTN first exam may be very similiar. If you see many pictures it will be easier to see the difference between RDS and TTN.

At the begining we checked our USG findings in Xray exam, we don't do it anymore. Just do USG exam.

great to learn that.

as you have said we need to print pictures of artifacts- amazing to know how artifacts help

I use daily lung ultrasound in my NICU. The pattern of RDS is different from that of TTN. In RDS you see white lung (compact B lines from apex to the base of the lungs) while in TTN you have a diagnostic sign: the double lung point in which you see at the base compact B lines that are sharply divided from normal A lines of the superior area of the lung. This border point is diagnostic of TTN and specific in 100% of the cases.

@vito62 - does this mean that you need to do less plain X-rays. If yes, have you estimated how many less x-ray investigations you need?

Yes, surely I need less X-rays for pneumonia follow up or to exclude a PNX for example before or after surfactant administration, but for legal questions often I need to confirm the diagnosis with X-ray 

I think lung echography is very useful in RDS diagnosis (I love it because it's possible to confirm or rule out Transitory Tachypnea, and save a Surfactant administration). Diagnosis of air leak is less easy than it's written on Sciptures and it's impossible to detect a pneumomediastinum.  You can find more pleural effusion than X-Ray, but we use US in this case to check the evolution of pneumonia rather than primitive diagnosis.

Anyway, I' think there are so many articles in literature about diagnosis of RDS by US that a legal problem it's not so real.