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Correspondence |

Clinical Data Are Essential to Validate Lung Ultrasound FREE TO VIEW

Francesco Raimondi, MD, PhD; Fiorella Migliaro, MD; Daniele De Luca, MD, PhD; Nadya Yousef, MD; Javier Rodriguez Fanjul, MD
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Editor's Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

On behalf of NeoLUS, an international, collaborative group on Lung Ultrasound on the Neonate and Small Infant (Bedside-lung-ultrasound-for-the-neonate-and-small infant/1546519678896741; https://www.facebook.com/groups/1493243264284547).

CORRESPONDENCE TO: Francesco Raimondi, MD, PhD, Università “Federico II” - Department of Translational Medical Sciences via Pansini 5, Naples 80131, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(6):1575. doi:10.1016/j.chest.2016.02.685
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We read with great attention the article by Liu et al in a recent issue of CHEST (May 2016) regarding ultrasound diagnostic criteria of transient tachypnea of the neonate (TTN). It is an unmasked, retrospective series by a single ultrasonographer that reaches conclusions different from what had been previously described.,,, Liu et al show that no ultrasound picture is unique to TTN and basically not distiguishable from respiratory distress syndrome (RDS). They also allude to a different ultrasound appearance between the acute vs the convalescent patient with TTN. Although some degree of overlapping is acknowledged, TTN and RDS are different diseases. The former results from delayed clearing of lung fluid, particularly frequent in late preterm infants. The latter is due to deficient surfactant production, a common feature of significant prematurity.

We are concerned that the important diagnostic statements made by Liu et al regarding common and potentially harmful diseases do not include appropriate and extensive references to clinical data. The investigators do not report the general clinical characteristics nor do they report on the evolution of infants with TTN. No definition of RDS is given, and it is unclear how many infants received endotracheal surfactant. The patient allocation process is not described, which is a crucial step to correctly investigate diagnostic accuracy.

At ultrasound, all infants in both groups present with an abnormal pleural line and A-line disappearance. Lacking a clear reference to gestational age, there is a substantial chance that some premature infants had RDS rather than TTN. Similarly, no difference on severe vs mild (or acute vs healing) TTN can be stated without clinical (eg, Silverman score) or blood gases criteria.

Although Liu et al are to be commended for their attempt to promote a noninvasive and radiation-free technique such as lung ultrasound, we urge caution when essential methodology is neglected. The issue of TTN ultrasound diagnosis deserves an appropriately powered, prospective, multicenter study with a sound correlation between ultrasound and clinical data.

References

Liu J. .Chen X.X. .Li X.W. .Chen S.W. .Wang Y. .Feng Z.C. . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;149:1269-1275 [PubMed]journal. [CrossRef] [PubMed]
 
Vergine M. .Copetti R. .Brusa G. .et al Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology. 2014;106:87-93 [PubMed]journal. [PubMed]
 
Raimondi F. .Cattarossi L. .Copetti R. . International perspectives: point-of-care chest ultrasound in the neonatal intensive care unit: an Italian perspective. NeoReviews. 2014;15:e2-e6 [PubMed]journal. [CrossRef]
 
Brat R. .Yousef N. .Klifa R. .et al Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr. 2015;169:e151797- [PubMed]journal. [CrossRef] [PubMed]
 
Raimondi F. .Migliaro F. .Sodano A. .et al Use of neonatal chest ultrasound to predict noninvasive ventilation failure. Pediatrics. 2014;134:e1089-e1094 [PubMed]journal. [CrossRef] [PubMed]
 

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Tables

References

Liu J. .Chen X.X. .Li X.W. .Chen S.W. .Wang Y. .Feng Z.C. . Lung ultrasonography to diagnose transient tachypnea of the newborn. Chest. 2016;149:1269-1275 [PubMed]journal. [CrossRef] [PubMed]
 
Vergine M. .Copetti R. .Brusa G. .et al Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology. 2014;106:87-93 [PubMed]journal. [PubMed]
 
Raimondi F. .Cattarossi L. .Copetti R. . International perspectives: point-of-care chest ultrasound in the neonatal intensive care unit: an Italian perspective. NeoReviews. 2014;15:e2-e6 [PubMed]journal. [CrossRef]
 
Brat R. .Yousef N. .Klifa R. .et al Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr. 2015;169:e151797- [PubMed]journal. [CrossRef] [PubMed]
 
Raimondi F. .Migliaro F. .Sodano A. .et al Use of neonatal chest ultrasound to predict noninvasive ventilation failure. Pediatrics. 2014;134:e1089-e1094 [PubMed]journal. [CrossRef] [PubMed]
 
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