IMAGING IN NEONATAL EMERGENCY

Indrastuti Normahayu
Fakultas Kedokteran Universitas Brawijaya
2019

Malang Radiology Scientific Meeting 2019

Preface
Problems of NICU patients:
• Congenital anomaly
• Acquired
• Trauma
Still needs better understanding about newborn diseases  no specific signs and
symptoms

Malang Radiology Scintific Meeting 2019

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For example:
• Central cyanosis: abnormalities from respiratory system, cardiac, central
nervous system, hematologic, or metabolic.
• Pallor: acute bleeding, hypoxia, asphyxia, hypoglycaemia, septic, shock, or
adrenal anomaly.
• Hypotension: hypovolemic shock, septic shock, heart failure, pneumothorax,
pneumopericardium, pericardial effusion, or adrenal anomaly

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• Seizure: CNS abnormalities : ischemic encephalopathy, intracranial bleeding,
cerebral anomaly, subdural effusion, meningitis, hypocalcemia, hypoglycemia,
cerebral infarction, familial seizure, etc
• Lethargy: infection, asphyxia, hypoglycaemia, hypercapnia, or sedation.

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Alat bantu yang digunakan pada pasien
NICU
• VP shunt
• ETT
• OGT/NGT
• CVC
• Umbilical cateter
Pada imejing harus dinilai posisi dari alat bantu dan komplikasi bila terjadi mal position

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 Umbilical Artery Catheterization
• Direct access to the arterial system : arterial blood pressure, blood sampling, IV access to fluids and
medication
• From umbilical artery, through internal iliac artery to aorta
• High position : T6- T9 ( less vascular complication )
• Low position : L3-L5
• The findings are :
1. Umbilical artery line in a good high position
2. Malposition folded in aorta abdominalis
3. Deep position in aortic arch

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Umbilical vein catheter
• Umbilic vein into the left portal vein, through ductus venosus into a hepatic vein and IVC, the tip level of
diaphragm
• Malposition :
• - low position
• - intra hepatic into portal venous system , right and left, superior mesenteric vein, splenic vein
• - perforation
• - deep position ( right atrium )

• radiologyassistant.nl

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Type of imaging
• Chest x ray, mobile x ray
• Babygram
• Ultrasound , brain, chest , abdomen, etc

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 Malposition of umbilical arteri
line folded in the abdominal aorta

Newborn, 0 day old…Babygram imaging 9

Malposition of umbilical vein line in
right portal vein

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 Ventricular drain

1 year old girl

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Neonates, 10 days old

Atresia oesophagus (TEF)

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Neonates, 20 days old

Good position of gastric tube, double bubble sign

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Neonates, 2 days old, atresia ani
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Neonates, 3 days old, anus
imperforatus
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Neonates, 3 days old, AP – knee chest position

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Neonates, 0 day old

Umbilical vein line in right portal vein

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Low level bowel
obstruction 18
ETT Position :
thoracic aperture
- 1 centimeter
above carina

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Low level bowel obstruction

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Obstructive atelectasis
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Baby, 26 days
Neonatal
pneumonia

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Newborn
Good Position ETT

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Neonates, 20 days old,
bilateral pneumothorax
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SDH frontotemporo
parieto sinistra

Koleksi : dr. Arss

Budi

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Ventilator weaning
• Gradual process of decreasing ventilator support
• Delayed weaning can lead :
• 1. ventilator induced lung injury (VILI)
• 2. ventilator associated pneumonia (VAP)
• 3. ventilator induced diaphragmatic dysfunction

• Premature : loss of the airway, defective gas exchange, aspiration, respiratory muscle fatique

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Spontaneous breathing trial (SBT)
• Patient’s ability to breathe while receiving minimal or no ventilator support
• Ultrasound examination : diaphragmatic dysfunction by measuring the difference between diaphragm
thickness at the end of inspiration and expiration using USG to view the diaphragm in the zone of
apposition. They found that a difference of 30% or more could predict extubation failure
• Diaphragmatic disfunction : excursion < 4mm, difference > 50% between the excursion of one
hemidiaphragm compared to the other

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Diaphragm Ultrasound
• To predict weaning outcome, using:
1. Modified lung ultrasound score (LUSm)
2. Thickening diapragm index (TI)
• High LUSm and low TI indicate high risk of weaning failure

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• Diaphragm thickness were measured by using 7-10 MHz linier probe on the mid axillary line between 8 th
-10th ICS, in semi decubitus position
• M-mode: hypoechoic structure between 2 echoic lungs
• Measuring the diaphragm thickness at the end expiration and end inspiration phase
• Formula: (end expiratory diaphragm thickness - end inspiratory diaphragm thickness)/end inspiratory
diaphragm thickness

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Seok et al. 2017. Ultrasonographic findings of the normal diaphragm: thickness and contractility. Annals of Clinical Neurophysiology 33
Evaluasi diafragma
• Tebal : sekitar 1mm
• Gunakan M mode, dinilai secara dinamik, peranjakan saat inspirasi dan ekspirasi, bandingkan kedua sisi
• Bila tidak ada pergerakan : paralisis

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Kesimpulan
• Bayi baru lahir sampai neonatus, rentan terhadap radiasi , X ray, USG thorax digunakan untuk evaluasi
terapi dan perkiraan pelepasan ventilator
• USG bisa digunakan pada hampir seluruh organ
• Menilai posisi alat bantu yang terpasang , kelainan dan komplikasi yang terjadi bila malposition

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•Terima kasih...

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