Lung ultrasound in neonates under cardiac surgery: feasible and predictive.

IF 3 3区 医学 Q1 PEDIATRICS
European Journal of Pediatrics Pub Date : 2024-12-01 Epub Date: 2024-09-27 DOI:10.1007/s00431-024-05782-2
R Gregorio-Hernández, S Vigil-Vázquez, C Ramos-Navarro, A Pérez-Pérez, E Rodríguez-Corrales, M Arriaga-Redondo, M Sánchez-Luna
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引用次数: 0

Abstract

Purpose: To determine whether pre- and postoperative follow-up based on lung ultrasound is associated with the respiratory and clinical evolution of patients undergoing cardiac surgery in the neonatal period.

Methods: Prospective observational unicentric study from December 2020 to October 2023 in a neonatal intensive care unit, a referral center for congenital heart diseases (CHD). Neonates with CHD exposed to heart surgery or percutaneous catheterization in their first 28 days of life were included. LU follow-up was performed before surgery (LUSpre) and on days 1 (LUS_1), 3 (LUS_3), and 7 (LUS_7) afterwards by mean of a dedicated score (LUS) ranging from 0 to 3 points in 8 areas (total score 0-24).

Results: Fifty-five neonates were included. Median gestational age was 39.1 weeks (37.8-40.1), birth weight 3088 g (IQR 2910-3400). Forty-nine received surgery and 6 only percutaneous catheterization. Median LUSpre score was associated with total respiratory support in the first 30 postoperative days (p = 0.034). Median postoperative LUS was significantly higher than LUSpre in the surgery cohort at all time points (p < 0.05). LUS_1 was associated with respiratory and several clinical outcomes: for each point increase in the ultrasound score, the days on invasive mechanical ventilation, the need for any respiratory support within the first 30 postoperative days, and the length of NICU stay increased significantly (p < 0.05). The presence of consolidations in any area in the postoperative lung ultrasounds was associated with worse respiratory outcomes: higher invasive mechanical ventilation duration (6.84 days), longer total respiratory support (6.07 days), and NICU admission (21.61 days). The presence of consolidations in LUS_7 was significantly associated with the occurrence of ipsilateral diaphragmatic paralysis (odds ratio of 10.25 (95% CI 2.05-51.26, p = 0.006).

Conclusion: Performance of lung ultrasound follow-up in CHD in the NICU is feasible and predictive of the respiratory evolution of the patient. LUS_1 presented the highest predictive values. The presence of consolidations is associated with a worse respiratory evolution and if they persist for a week after the procedure, it may raise suspicion of ipsilateral diaphragmatic paralysis.

对接受心脏手术的新生儿进行肺部超声检查:可行性和预测性。
目的:确定基于肺部超声的术前和术后随访是否与新生儿期心脏手术患者的呼吸和临床演变相关:2020年12月至2023年10月在先天性心脏病(CHD)转诊中心的新生儿重症监护室进行前瞻性单中心观察研究。研究对象包括在出生后 28 天内接受过心脏手术或经皮导管插入术的先天性心脏病新生儿。在手术前(LUSpre)和手术后第1天(LUS_1)、第3天(LUS_3)和第7天(LUS_7)进行LU随访,在8个方面(总分0-24分)进行0-3分的专用评分(LUS):结果:共纳入 55 名新生儿。中位胎龄为 39.1 周(37.8-40.1),出生体重为 3088 克(IQR 2910-3400)。49名新生儿接受了手术治疗,6名新生儿仅接受了经皮导管治疗。LUSpre 评分中位数与术后前 30 天的总呼吸支持有关(p = 0.034)。手术组的术后 LUS 中位数在所有时间点均明显高于 LUSpre(p 结论:术后 LUS 中位数明显高于 LUSpre:在新生儿重症监护室对患有先天性心脏病的患者进行肺部超声随访是可行的,而且可以预测患者的呼吸系统变化。LUS_1 的预测值最高。合并症的出现与呼吸系统恶化有关,如果合并症在术后持续一周,则可能会引起对同侧膈肌麻痹的怀疑。
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来源期刊
CiteScore
5.90
自引率
2.80%
发文量
367
审稿时长
3-6 weeks
期刊介绍: The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.
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