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Jing Liu, MD, PhD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

CORRESPONDENCE TO: Jing Liu, MD, PhD, Department of Neonatology and NICU of Bayi Children’s Hospital, the Army General Hospital of the Chinese PLA, Beijing 100700, China.


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


Chest. 2016;149(6):1575-1576. doi:10.1016/j.chest.2016.03.022
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We thank Raimondi et al for their attention and insightful comments in response to our recent publication describing how ultrasound is used to diagnose transient tachypnea of newborns (TTN). Raimondi et al have conducted a large amount of research in this field, and reviewing their publications has increased our knowledge.

Previously, we had believed that the “double lung point” was a specific ultrasound sign of TTN. However, as our experience with lung ultrasound at our NICU (a Level III center with 350 beds and 8,000 to 10,000 neonates admitted per year) has increased, we have found that this scenario is not always the case. Although there are no specific ultrasound signs of TTN, ultrasound does help to differentiate between TTN and respiratory distress syndrome (RDS). TTN typically manifests as pulmonary edema on ultrasound, whereas RDS typically manifests as lung consolidation with air bronchograms; thus, the presence of lung consolidation on ultrasound helps rule out TTN.,

The diagnostic criteria for TTN were included in our article, whereas those for other diseases, such as RDS and meconium aspiration syndrome, and other related clinical information were not included because the aim of the study was to investigate the diagnosis of TTN. We do not believe that the information presented will impact the methods used to diagnosis diseases other than TTN using ultrasound.

We agree with Raimondi et al that a multicenter, prospective study would greatly aid in the reliability and accuracy of findings regarding the use of ultrasound in the diagnosis of lung disease. However, such a study may lead to other issues because, first, “gold standards” diagnostic criteria do not always result in a correct diagnosis (eg, RDS). According to Neonatal Respiratory Disorder, 77% of cases diagnosed as RDS are actually TTN. Thus, the use of traditional diagnostic criteria results in a high misdiagnosis rate for neonatal lung diseases. Traditionally, RDS was considered to be pathologically characterized by atelectasis caused by pulmonary surfactant deficiency, and this condition manifests on chest radiograph as a uniform reduction in light permeability or ground-glass or “white lung” changes in the lungs. However, lung ultrasound findings have greatly changed the characterization of RDS., Atelectasis or lung consolidation may dominate one side while pulmonary edema dominates the other side, or edema and/or effusion may dominate one lobe while lung consolidation dominates another lobe. Lung lesions of varying nature and severity may be present on the same side as atelectasis, lung consolidation, edema, and/or effusion or on the opposite side. Second, we cannot be sure that the diagnostic accuracy would always be the same if lung ultrasound was performed by different operators in the same or different medical centers, whereas our center has enough cases to complete such kinds of clinical investigations.

In a summary, although a great deal of research has been conducted and used to develop into international evidence-based recommendations for lung ultrasound, we believe that lung ultrasound is still in its early stages. Much more research must be conducted to obtain a thorough understanding of lung ultrasound to accurately diagnose lung diseases.

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]
 
Liu J. .Cao H.Y. .Wang H.W. .et al The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr. 2014;24:147-154 [PubMed]journal. [PubMed]
 
Liu J, Cao HY, Wang XL, et al. The significance and the necessity of routinely performing lung ultrasound in the neonatal intensive care units [published online ahead of print March 3, 2016].J Matern Fetal Neonatal Med.http://dx.doi.org/10.3109/14767058.2016.1152577.
 
Greenough A. . Transient tachypnea of the newborn.Greenough A..Milner A.D.. Neonatal Respiratory Disorder.  :272-277 [PubMed]journal
 
Volpicelli G. .Elbarbary M. .Blaivas M. .et al International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577-591 [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]
 
Liu J. .Cao H.Y. .Wang H.W. .et al The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr. 2014;24:147-154 [PubMed]journal. [PubMed]
 
Liu J, Cao HY, Wang XL, et al. The significance and the necessity of routinely performing lung ultrasound in the neonatal intensive care units [published online ahead of print March 3, 2016].J Matern Fetal Neonatal Med.http://dx.doi.org/10.3109/14767058.2016.1152577.
 
Greenough A. . Transient tachypnea of the newborn.Greenough A..Milner A.D.. Neonatal Respiratory Disorder.  :272-277 [PubMed]journal
 
Volpicelli G. .Elbarbary M. .Blaivas M. .et al International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38:577-591 [PubMed]journal. [CrossRef] [PubMed]
 
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