title: Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate.
abstract: To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient.
  
  
  
  In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation <65% for more than 40 seconds) and bradycardia or sudden increase of oxygen requirement by at least 50% in less than 10 minutes with a final fraction of inspired oxygen ≥0.7 to keep stable saturations. All eligible patients had an ultrasound scan before undergoing a chest radiograph, which was the reference standard.
  
  
  
  Forty-two infants (birth weight = 1531 ± 812 g; gestational age = 31 ± 3.5 weeks) were enrolled in 6 centers; pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases.
  
  
  
  Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage.
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy. Electronic address: raimondi@unina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raimondi
authors.affiliation: Division of Neonatology, Hospital San Joan de Deú, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Rodriguez Fanjul
authors.affiliation: Division of Neonatology, Ospedali Civili, Brescia, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Aversa
authors.affiliation: Division of Neonatology, Ospedali Civili, Brescia, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Chirico
authors.affiliation: Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France.
authors.forename: Nadya
authors.initials: N
authors.lastname: Yousef
authors.affiliation: Division of Pediatrics and Neonatal Critical Care, South Paris University Hospitals-APHP, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.affiliation: Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy.
authors.forename: Iuri
authors.initials: I
authors.lastname: Corsini
authors.affiliation: Division of Neonatology, Ospedale Careggi, University of Florence, Florence, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Dani
authors.affiliation: Division of Neonatology, Ospedale Rummo, Benevento, Italy.
authors.forename: Lidia
authors.initials: L
authors.lastname: Grappone
authors.affiliation: Division of Neonatology, Ospedale Rummo, Benevento, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Orfeo
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Migliaro
authors.affiliation: Division of Pediatric Diagnostics, Department of Biomorphological and Functional Sciences, Università "Federico II," Naples, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Vallone
authors.affiliation: Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Capasso
mesh_terms: D016638:Critical Illness; D004322:Drainage; D004630:Emergencies; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging*; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000628:therapy; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: lung ultrasound; neonate; pneumothorax