title: Pulmonary ultrasonography in the follow-up of respiratory distress syndrome on preterm newborns. Reduction of X-ray exposure.
abstract: OBJECTIVE
  Respiratory distress syndrome (RDS) is the most common cause of respiratory failure in preterm neonates, whose lungs are often immature. The diagnosis and follow-up are based on clinical and radiographic findings. Due to the problem of air artifacts, ultrasonography (US) is not used routinely in the diagnosis of lung diseases. However, when the alveolar air content decreases, as it does in RDS, characteristic patterns appear that can be observed during US lung examinations. The aim of this study was to determine whether the use of chest radiographs in neonates with RDS could be reduced by the routine use of chest US for follow-up examinations.
  
  
  METHODS
  From April through September 2008, were enrolled all preterm newborns, with very low birth weight (VLBW), consecutive admitted in NICU with clinically and radiologically diagnosed RDS. We performed lung ultrasound examination in this patients. Video-taped US examinations were done every 8-12 h until clinical resolution of the disease was observed. Chest X-rays were performed only in unclear cases. We compared the number of chest radiographs obtained in the NICU during this period and during the preceding six months.
  
  
  RESULTS
  105 serial US lung examinations were performed in 21 preterm infant with clinically and radiologically diagnosed RDS. US lung examinations revealed "comet-tail" artifacts that were compact, diffuse, and symmetrically distributed throughout both lung fields. In 8 cases, the pleural line was also extensively thickened and irregular, and in 7 cases multiple subpleural hypoechoic areas indicative of lung consolidation were observed (mainly on posterior and lateral scans). The mean number of chest radiographs per infant performed in the NICU during the study period was significantly lower than that of the preceding six months (2.6 ± 1 versus 3.8 ± 1.5; p < 0.05).
  
  
  CONCLUSIONS
  Chest ultrasound is a valid alternative for the follow-up of VLBW infants with RDS, which can decrease the need for chest X-rays and reduce patient exposure to ionizing radiation.
authors: UOC Radiologia, Azienda Ospedaliera Sant'Andrea, Roma, Italy.
authors: M
authors: M
authors: Federici
authors: P V
authors: PV
authors: Federici
authors: F
authors: F
authors: Feleppa
authors: C
authors: C
authors: Gizzi
authors: R
authors: R
authors: Agostino
authors: A
authors: A
authors: Bellelli
authors: V
authors: V
authors: David
keywords: Ionizing radiation exposure; Neonates; Pulmonary ultrasonography; Respiratory distress syndrome
references: Med Phys. 2008 Feb;35(2):556-68
references: 18383677
references: World J Radiol. 2010 Jun 28;2(6):203-14
references: 21160632
references: Am J Respir Crit Care Med. 1997 Nov;156(5):1640-6
references: 9372688
references: Phys Med Biol. 1961 Apr;5:401-10
references: 13725043
references: Radiol Med. 2008 Mar;113(2):190-8
references: 18386121
references: Radiol Med. 2008 Oct;113(7):1079-80; author reply 1080-1
references: 19002418
references: Br J Radiol. 2002 Jul;75(895):590-5
references: 12145132
references: J Ultrasound Med. 2009 Feb;28(2):163-74
references: 19168766
references: Neonatology. 2008;94(1):52-9
references: 18196931
references: Crit Care Med. 2005 Jun;33(6):1231-8
references: 15942336
references: Radiographics. 2005 Jul-Aug;25(4):1047-73
references: 16009823
references: Radiology. 1994 Jun;191(3):681-4
references: 8184046
references: Med Sci Monit. 2006 Oct;12(10):CR440-6
references: 17006405
references: Chest. 1995 Nov;108(5):1345-8
references: 7587439
references: Neonatology. 2007;91(3):203-9
references: 17377407
references: Intensive Care Med. 1998 Dec;24(12):1331-4
references: 9885889