title: Lung ultrasound during the initiation of breathing in healthy term and late preterm infants immediately after birth, a prospective, observational study.
abstract: Lung ultrasound (LUS) has shown promise for evaluation of newborns with respiratory distress. However, no study has described the appearance of LUS during the initiation of breathing. We used LUS to describe the appearance of the lungs in healthy infants immediately after birth, starting with the infant's first breath, through the first 20min after birth.
  
  
  
  This was a single-center observational study enrolling neonates born at ≥35 weeks. We obtained LUS video recordings with the initiation of breathing. Recordings that captured one of the 1st four breaths after birth were included. We also obtained recordings at 1-10 and 11-20min after birth. Recordings were graded using a modified version of a previously published system, with additional grades to describe the appearance of the lungs prior to establishment of the pleural line.
  
  
  
  We studied 63 infants, mean gestational age=391/7±2 days, mean weight=3473g±422, 33 infants were delivered vaginally and 30 via cesarean section. We captured the first breath after birth in 28 infants and within the first four breaths from the remaining 35 infants. The pleural line was established by a median of 4 breaths (3-6). At the 1-10min examination, all infants had an established pleural line and 89% demonstrated substantial liquid clearance. At the 11-20min examination, all infants had substantial liquid clearance.
  
  
  
  Establishment of the pleural line, indicating lung aeration and substantial liquid clearance is achieved with the first few breaths after birth in term and near term infants.
authors.affiliation: Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: douglas.blank@thewomens.org.au.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Blank
authors.affiliation: Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: Sheryle R
authors.initials: SR
authors.lastname: Rogerson
authors.affiliation: Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: C Omar F
authors.initials: COF
authors.lastname: Kamlin
authors.affiliation: Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Fox
authors.affiliation: Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Neonatology, University Children's Hospital of Tübingen, Germany.
authors.forename: Laila
authors.initials: L
authors.lastname: Lorenz
authors.affiliation: The University of Melbourne, Department of Obstetrics and Gynecology, Melbourne, Australia; Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Kane
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Polglase
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Hooper
authors.affiliation: Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000000981:diagnostic imaging* / Q000502:physiology; D008297:Male; D011446:Prospective Studies; D012119:Respiration; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D014741:Video Recording
keywords: Delivery room; First breath; Lung aeration; Lung liquid; Lung ultrasound; Newborn