Dear Editor,
We read with interest Professor Jing Liu’s article entitled “Ultrasound diagnosis and grading criteria of neonatal respiratory distress syndrome” published in the first issue of this year’s Journal [Citation1]. Although the chest X-ray classification of respiratory distress syndrome (RDS) is well known, its scientific and practical application is greatly limited due to the inconsistency between X-ray findings and clinical manifestations. According to the results of their long-term study on lung ultrasound (LUS), Professor Jing Liu proposed the ultrasound grading method and grading criteria, that is Grade I (mild or early-stage RDS), Grade II (moderate RDS) and Grade III (severe RDS). This is a great innovation with much difference from X-ray grading. We believe that this grading method will play an important role in the diagnosis, treatment, and improved prognosis of neonatal RDS.
As ultrasound waves are totally reflected when they encounter gas, lung diseases have been considered as the "forbidden zone" of ultrasound diagnosis for a long time. Over the past decade, this "forbidden zone" has been completely broken.Through in-depth and systematic research, it is found that ultrasound can diagnose lung diseases, and compared with chest X-ray, LUS has higher accuracy and reliability and can avoid the misdiagnosis caused by X-ray [Citation2,Citation3]. During the recent COVID-19 pandemic, lung ultrasound as an easy-to-use, noninvasive and reliable method, proved to be useful in the detection of lung lesions in studies comprising neonates with COVID-19 pneumonia [Citation4].
Furthermore, LUS is an increasingly researched tool in the evaluation of neonatal RDS. LUS does not emit ionizing radiation and, therefore, it can be repeatedly applied to diagnose and monitor RDS and its complications. Reports have also documented an increased agreement among clinicians practicing LUS, as this method is highly subjective. However, surfactant replacement therapy does not seem to cause visible changes on LUS, probably limiting the usefulness of its clinical implementation. Furthermore, the use of LUS in neonatal intensive care is currently restricted by a lack of formal training resources to permit the acquisition and interpretation of images by clinicians [Citation5].
In this regard, the author from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, China, has made outstanding contributions, being one of the first experts to study neonatal LUS technology in the world and provide ultrasound diagnostic criteria for a variety of neonatal lung diseases, including neonatal pneumonia, meconium aspiration syndrome, pulmonary hemorrhage, wet lung, atelectasis, pneumothorax and bronchopulmonary dysplasia (BPD) [Citation6–13]. Importantly, since 2017, the author has led his team using LUS to completely replace X-ray in diagnosing neonatal lung diseases, so that all hospitalized infants can completely avoid radiation hazards [Citation14]. To the best of our knowledge, this is the only team in the world so far that has been able to use ultrasound instead of X-ray to diagnose lung disease in newborns. We suggest that the use of ultrasound instead of X-ray in the diagnosis of neonatal lung disease is an important milestone in the history of neonatal medicine and a revolutionary progress in neonatal medical technology.
In addition to diagnosis, the author and his team guided the "precision treatment" and "precision nursing" of lung diseases under ultrasound monitoring, which can successfully guide the application of ventilator and exogenous pulmonary surfactant, completely changing the traditional understanding and management of neonatal lung diseases and greatly improving the prognosis of severe cases [Citation15,Citation16]. More than 5 years of clinical practice has proved that the diagnosis and management of lung diseases under LUS monitoring has accomplished at least the following achievements: the frequency of ventilator use has been reduced by 40.2%; the duration of mechanical ventilation has been reduced by 67.5%; and ventilator weaning failure has been totally avoided. A misdiagnosis rate of 30% for RDS was also avoided. The dosage of pulmonary surfactant was significantly reduced by 50% to 75%. No BPD occurred in the LUS-based care group for more than 5 years. The mortality rates of RDS, as well as incidence of pneumothorax and pulmonary hemorrhage decreased by 100%. The poor prognosis rate of very low birth weight infants decreased by 85%, and the total mortality rate of hospitalized infants decreased by 90%.Therefore, the cost of LUS-based care was saved [Citation17].
In order to promote the development of LUS in Neonatology, Professor Jing Liu and his team have issued guidance documents, suggesting that everyone actively learn and master this technology [Citation18–20]. We also suggest that everyone try to visit Professor Jing Liu’s NICU, so as to better grasp and experience the charm of lung ultrasound.
Data sharing is not applicable to this article, no new data were created or analyzed in this study.
Additional information
Funding
References
- Liu J. Ultrasound diagnosis and grading criteria of neonatal respiratory distress syndrome. J Mat-Fetal Neonatal Med. 2023;36(1):1. doi: 10.1080/14767058.2023.2206943.
- Liu J, Lovrenski J, Hlaing AY, et al. Neonatal lung diseases: lung ultrasound or chest x-ray. J Maternal-Fetal Neonatal Med. 2021;34(7):1177–2. doi: 10.1080/14767058.2019.1623198.
- Liu J, Lovrenski J, Feletti F. Editorial: application of lung ultrasound in the management of pediatric lung diseases. Front Pediatr. 2023;11:1140403. doi: 10.3389/fped.2023.1140403.
- Stoicescu ER, Ciuca IM, Iacob R, et al. Is lung ultrasound helpful in COVID-19 neonates? – A systematic review. Diagnostics. 2021;11(12):2296. doi: 10.3390/diagnostics11122296.
- King A, Blank D, Bhatia R, et al. Tools to assess lung aeration in neonates with respiratory distress syndrome. Acta Paediatr. 2020;109(4):667–678. doi: 10.1111/apa.15028.
- Liu J, Liu F, Liu Y, et al. Lung ultrasonography for the diagnosis of severe pneumonia of the newborn. Chest. 2014;146(2):383–388. doi: 10.1378/chest.13-2852.
- Liu J, Chen SW, Liu F, et al. BPD, not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Zhongguo Dang Dai Er Ke Za Zhi. 2014;26(1):e133–18. doi: 10.1097/MD.0000000000000133.
- Liu J, Chen SW, Liu F, et al. The diagnosis of neonatal pulmonary atelectasis using lung ultrasonography. Chest. 2015;147(4):1013–1019. doi: 10.1378/chest.14-1306.
- Liu J, Chen XX, Li XW, et al. Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;149(5):1269–1275. doi: 10.1016/j.chest.2015.12. 024.
- Liu J, Cao HY, Fu W. Lung ultrasonography to diagnose meconium aspiration syndrome of the newborn. J Int Med Res. 2016;44(6):1534–1542. doi: 10.1177/0300060516663954.
- Liu J, Chi JH, Ren XL, et al. Lung ultrasonography to diagnose pneumothorax of the newborn. Am J Emerg Med. 2017;35(9):1298–1302. doi: 10.1016/j.ajem.2017.04.001.
- Ren XL, Fu W, Liu J, et al. Lung ultrasonography to diagnose pulmonary hemorrhage of the newborn. J Maternal-Fetal Neonatal Med. 2017;30(21):2601–2606. doi: 10.1080/14767058.2016.1256997.
- Liu J, Chi JH, Lu ZL, et al. The specific signs of lung ultrasound to diagnose pulmonary hemorrhage of the newborns: evidence from a multicenter retrospective case-control study. Front Pediatr. 2023;11:1090332. doi: 10.3389/fped.2023.1090332.
- Gao YQ, Qiu RX, Liu J, et al. Lung ultrasound completely replaced chest X-ray for diagnosing neonatal lung diseases: a 3-year clinical practice report from a neonatal intensive care unit in China. J Maternal-Fetal Neonatal Med. 2022;35(18):3565–3572. doi: 10.1080/14767058.2020.1830369.
- Liu J, Ren XL, Fu W, et al. Bronchoalveolar lavage for the treatment of neonatal pulmonary atelectasis under lung ultrasound monitoring. J Maternal-Fetal Neonatal Med. 2017;30(19):2362–2366. doi: 10.1080/14767058.2016.1248935.
- Liu J, Fu W, Qin SJ. Lung ultrasound to guide the administration of exogenous pulmonary surfactant in respiratory distress syndrome of newborn infants: a retrospective investigation study. Front Pediatr. 2022;10:952315. doi: 10.3389/fped.2022.952315.
- Liu J, Zhang X, Wang Y, et al. The outcome- or cost-effectiveness analysis of LUS-Based care or CXR-Based care of neonatal lung diseases: the clinical practice evidence from a leve III NICU in China. Diagnostics. 2022;12(11):2790. doi: 10.3390/diagnostics12112790.
- Liu J, Copetti R, Sorantin E, et al. Protocol and guidelines for point-of-care lung ultrasound in diagnosing neonatal pulmonary diseases based on international expert consensus. J Vis Exp. 2019;145(145):e58990. doi: 10.3791/58990.
- Liu J, Kurepa D, Feletti F, et al. International expert consensus and recommendations for neonatal pneumothorax ultrasound diagnosis and ultrasound-guided thoracentesis procedure. J Vis Exp. 2020;157(157):e60836. doi: 10.3791/60836.
- Liu J, Guo G, Kurepa D, et al. Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination. J Maternal- Fetal Neonatal Med. 2022;35(5):1003–1016. doi: 10.1080/14767058.2021.1940943.