Lung ultrasound for neonatal

cardio-respiratory conditions
Daniele De Luca (MD, PhD)
Director, Division of Pediatrics and Neonatal Critical Care
Associate Professor of Neonatology
South Paris University Hospitals, Medical Center “A.Beclere”
& Dept of Anesthesia and Critical Care, Catholic University of the Sacred Heart, Rome

ESPNIC Respiratory Section Deputy Chair

ESPR Scientific Content Manager and Officer for accreditation
For a long time thought to be useless

Air generated artifacts are useful because they are the

NORMAL FINDINGS

It took years to recognise these and their

absence/modifications (QUALITATIVE)

It is taking time to measure these (QUANTITATIVE)

Learning curve is paradoxically SHORT

Multiple possible uses and advantages

Bedside No transfer of small critical
patients

Immediate Results immediately

available
Cheap A US device is already
present in each ICU

Safe No radiations
Hand held Useful for procedures
Reproducible Checking the trend serially

Possible to simulate Hand model (Acad Emerg Med 2012)

Xirouchaki N et al. Intensive Care Med 2011

OVERALL
ACCURACY
Consolidation PNX Interstial Effusion
syndrome
Chest XR 49% 89% 58% 69%
US 95% 92% 94% 100%
Via G et al.
Min Anestesiol 2012
Cardiogenic lung oedema
 7 mm
Thickening of septa
Anderson KL et al, J Clin Ultrasound 2013
ARDS & Lung recruitment
 Complete loss of aeration

3 mm
Diffuse oedema
Bohuemad B et al. Am J Resp Crit Care Med 2011
Bohuemad B et al. Am J Resp Crit Care Med 2011
Via G et al.
Min Anestesiol 2012
Via G et al. Min Anestesiol 2012
30 days-infant with ARDS
Brat R et al. JAMA Pediatr 2014
Brat R et al. JAMA Pediatr 2014
Post heart-lung transplantation
BON

PICU - UCSC 2013

Wet lung
 UP Down

Normal
6h
2 4 -3
Especially
r in
UP a Down
DX
pe
p
i s a
D 7 mm
Wet

Copetti R, Neonatology 2007

100% sensitivity – 100% specificity
iRDS
 iRDS
I II
+ reliable after
the first 12
hours

Changing with

III time

Changing with IV
therapy !!!
 3 mm

100% sensitivity – 100% specificity

with no spared areas Copetti R, Neonatology 2008
With various evolutions (not like TTN…)
PRE SURF POST SURF
Before

After

Copetti R, Neonatology 2008 confirmed by animal data (Copetti R, J Perinat Med 2010)
Brat R et al. JAMA Pediatr 2014
MAS
MAS
Pneumonia/Bronchiolitis
Lobar

Pleural line hypo

Multiple parenchymal signs

Connatal

Diffuse signs
Viral or bacterial ???
BPD - VILI
PICU - UCSC 2012

PICU - UCSC 2012

normal iRDS BPD
E-PAS 2013; 4518.314
Thank you for your
attention!