Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Ultrasound Med Biol. 2021 Mar;47(3):359-369. doi: 10.1016/j.ultrasmedbio.2020.11.011. Epub 2020 Dec 16.
Neonatal pneumothorax is a life-threatening condition. Chest X-ray is the main diagnostic method but has some defects. Lung ultrasound has emerged as a diagnostic method in recent years. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against chest X-ray in neonates with pneumothorax. We searched the Chinese journal full-text database, Wanfang database, China biomedical document service system, Weipu Chinese science and technology periodical full-text database, EMBASE, PubMed, The Cochrane Library and Web of Science (up to January 2020) for prospective studies on the diagnostic accuracy of lung ultrasound in neonates with pneumothorax. Statistical analysis was undertaken using Meta-DiSc software, version 1.4 (Romany Cajal Hospital, Madrid, Spain). The search returned 528 studies, of which 8 full texts were assessed for eligibility against the inclusion/exclusion criteria. The overall specificity and sensitivity of lung ultrasound in the diagnosis of neonatal pneumothorax was 98% (95% confidence interval [CI]: 0.94-0.99) and 99% (95% CI: 0.98-1.00), respectively. The diagnostic odds ratio was 920.01 (95% CI: 265.81-3184.33), and the area under the curve was 0.996 7 (Q* = 0.978 5). However, the chest X-ray was always taken as the reference standard with a sensitivity of 82% (95% CI: 0.72-0.90), a specificity of 96% (95% CI: 0.90-0.99) and a diagnostic odds ratio of 44.54 (95% CI: 4.30-460.98). Study analysis studies indicated that the sensitivity of lung ultrasound in diagnosing pneumothorax excepted chest X-ray as the single diagnosis criteria was 98% (95% CI: 0.93-1.00), the specificity was 100% (95% CI: 0.96-1.00) and the diagnostic odds ratio was 965.39 (95% CI: 161.195781.93), showing a higher accuracy than chest X-ray. In conclusion, lung ultrasound had better sensitivity and specificity than chest X-ray in the diagnosis of pneumothorax. Some ultrasonic signs (absence of lung sliding or B-lines) had a high sensitivity in the diagnosis, which could be used to diagnose pneumothorax. Lung point could help judge the severity of pneumothorax. Its presence indicates that pneumothorax is mild to moderate; otherwise, pneumothorax is severe.
新生儿气胸是一种危及生命的疾病。胸部 X 射线是主要的诊断方法，但存在一些缺陷。近年来，肺部超声已成为一种诊断方法。本综述的目的是比较肺部超声与胸部 X 射线在气胸新生儿中的诊断准确性。我们检索了中文期刊全文数据库、万方数据库、中国生物医学文献服务系统、维普中文科技期刊全文数据库、EMBASE、PubMed、The Cochrane Library 和 Web of Science（截至 2020 年 1 月）中关于肺部超声在气胸新生儿中的诊断准确性的前瞻性研究。使用 Meta-DiSc 软件（西班牙马德里 Romany Cajal 医院）进行统计分析。搜索结果返回 528 项研究，其中 8 项全文研究根据纳入/排除标准进行了评估。肺部超声诊断新生儿气胸的总体特异性和敏感性分别为 98%（95%置信区间 [CI]：0.94-0.99）和 99%（95% CI：0.98-1.00）。诊断比值比为 920.01（95% CI：265.81-3184.33），曲线下面积为 0.996 7（Q*=0.978 5）。然而，胸部 X 射线始终被用作参考标准，其敏感性为 82%（95% CI：0.72-0.90），特异性为 96%（95% CI：0.90-0.99），诊断比值比为 44.54（95% CI：4.30-460.98）。研究分析表明，除将胸部 X 射线作为单一诊断标准外，肺部超声诊断气胸的敏感性为 98%（95% CI：0.93-1.00），特异性为 100%（95% CI：0.96-1.00），诊断比值比为 965.39（95% CI：161.195781.93），准确性高于胸部 X 射线。总之，肺部超声在诊断气胸方面的敏感性和特异性均优于胸部 X 射线。一些超声征象（无肺滑动或 B 线）在诊断中具有较高的敏感性，可用于诊断气胸。肺点有助于判断气胸的严重程度。其存在表明气胸为轻度至中度；否则，气胸为重度。
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