Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study
Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study
复制标题
DOI：
10.1136/archdischild-2017-312818
复制
发表时间：
2018-03-01
影响因子：
4.4
通讯作者：
Davis, Peter G.
中科院分区：
文献类型：
--
作者：
Blank, Douglas A.;Kamlin, C. Omar Farouk;Davis, Peter G.
目的肺超声（LUS）作为新生儿呼吸窘迫的诊断工具，具有良好的应用前景。没有研究描述过“正常”过渡期间的LUS。我们的目标是描述健康新生儿从出生后的最初几分钟到气道液体清除的连续LUS的表现。研究设计前瞻性观察性研究。设置单中心三级围产期中心在澳大利亚。115例出生在bb0 = 35孕周，平均（SD）孕周386/7周+/- 11天，平均出生体重3380 +/- 555 g的婴儿中，51例顺产，14例分娩后剖腹产，50例选择剖腹产。我们分别在出生后1-10分钟、11-20分钟和1、2、4、24小时通过左右腋窝连续拍摄LUS视频。根据先前验证的系统，对LUS视频的通气和液体清除进行分级。结果我们分析了1168个LUS视频记录。经LUS评估，肺通气和气道液体清除发生迅速。所有婴儿在第一次检查时均有胸膜线（中位数=2（1-4）分钟）。只有14%的婴儿在出生后10分钟有大量的液体潴留。49%、78%和100%的婴儿分别在2、4和24小时完成气道液体清除。结论在健康的过渡期新生儿中，肺通气和部分液体清除在出生后的最初几分钟内实现，而完全液体清除通常在出生后的最初4小时内实现。
Objective Lung ultrasound (LUS) has shown promise as a diagnostic tool for the evaluation of the newborn with respiratory distress. No study has described LUS during 'normal' transition. Our goal was to characterise the appearance of serial LUS in healthy newborns from the first minutes after birth until airway liquid clearance is achieved.Study design Prospective observational study.Setting Single-centre tertiary perinatal centre in Australia.Patients Of 115 infants born at >= 35 weeks gestational age, mean (SD) gestational age of 386/7 weeks +/- 11 days, mean birth weight of 3380 +/- 555 g, 51 were delivered vaginally, 14 via caesarean section (CS) after labour and 50 infants via elective CS.Interventions We obtained serial LUS videos via the right and left axillae at 1-10 min, 11-20 min and 1, 2, 4 and 24 hours after birth.Main outcome measures LUS videos were graded for aeration and liquid clearance according to a previously validated system.Results We analysed 1168 LUS video recordings. As assessed by LUS, lung aeration and airway liquid clearance occurred quickly. All infants had an established pleural line at the first examination (median=2 (1-4) min). Only 14% of infants had substantial liquid retention at 10 min after birth. 49%, 78% and 100% of infants had completed airway liquid clearance at 2, 4 and 24 hours, respectively.Conclusions In healthy transitioning newborn infants, lung aeration and partial liquid clearance are achieved on the first minutes after birth with complete liquid clearance typically achieved within the first 4 hours of birth.