Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II", Naples, Italy,
Division of Pediatrics and Neonatal Critical Care, Medical Centre "A. Béclère", South Paris University Hospitals, APHP, Paris, France.
Neonatology. 2019;115(3):263-268. doi: 10.1159/000495911. Epub 2019 Feb 7.
Discordant results that demand clarification have been published on diagnostic lung ultrasound (LUS) signs of transient tachypnea of the neonate (TTN) in previous cross-sectional, single-center studies. This work was conducted to correlate clinical and imaging data in a longitudinal and multicenter fashion.
Neonates with a gestational age of 34-40 weeks and presenting with TTN underwent a first LUS scan at 60-180 min of life. LUS scans were repeated every 6-12 h if signs of respiratory distress persisted. Images were qualitatively described and a LUS aeration score was calculated. Clinical data were collected during respiratory distress.
We enrolled 65 TTN patients. Thirty-one (47.6%) had a sharp echogenicity increase in the lower lung fields (the "double lung point" or DLP sign). On admission, there was no significant difference between patients with and without DLP in Silverman scores (4 ± 1.5 vs. 4 ± 2.1; p = 0.9) or LUS scores (7.6 ± 2.6 vs. 5.6 ± 3.8; p = 0.12); PaO2/FiO2 (249 ± 93 vs. 252 ± 125; p = 0.91). All initial LUS scans (performed at the onset of distress) and 99.5% of all scans showed a regular pleural line with no consolidation, with only 1 neonate showing consolidation in the follow-up scans. The Silverman and LUS scores were significantly correlated (rho = 0.27; p = 0.02).
A regular pleural line with no consolidation is a consistent finding in TTN. The presence of a DLP is not essential for the LUS diagnosis of TTN. A semi-quantitative LUS score correlates well with the clinical course and could be useful in monitoring changes in lung aeration during TTN.
在之前的横断面、单中心研究中，关于新生儿暂时性呼吸急促（TTN）的诊断性肺部超声（LUS）征象，已经发表了一些需要澄清的不一致结果。本研究旨在以纵向和多中心的方式对临床和影像学数据进行相关性分析。
胎龄为 34-40 周且出现 TTN 的新生儿在生后 60-180 分钟时进行首次 LUS 扫描。如果存在呼吸窘迫迹象，则每 6-12 小时重复进行 LUS 扫描。对图像进行定性描述，并计算 LUS 充气评分。在呼吸窘迫期间收集临床数据。
我们共纳入了 65 例 TTN 患者。其中 31 例（47.6%）下肺野出现锐利的回声增强（“双肺点”或 DLP 征）。入院时，有 DLP 征与无 DLP 征的患儿 Silverman 评分（4±1.5 比 4±2.1；p=0.9）或 LUS 评分（7.6±2.6 比 5.6±3.8；p=0.12）均无显著差异；PaO2/FiO2（249±93 比 252±125；p=0.91）。所有初始 LUS 扫描（在出现窘迫时进行）和所有扫描的 99.5%均显示规则的胸膜线，无实变，仅 1 例新生儿在随访扫描中出现实变。Silverman 评分和 LUS 评分显著相关（rho=0.27；p=0.02）。
在 TTN 中，规则的胸膜线无实变是一个一致的发现。DLP 征的存在并非 LUS 诊断 TTN 的必要条件。半定量 LUS 评分与临床病程相关性良好，可用于监测 TTN 期间肺充气的变化。
