Ultrasonographic Fetal Lung Texture Analysis in the Prediction of Neonatal Respiratory Morbidity.

Transient tachypnea of the newborn (TTN) is one of the most common causes of perinatal dyspnea and is traditionally diagnosed by chest x-ray. This study aimed to explore the diagnostic value of lung ultrasonography (LUS) for TTN as well as differentiate it from respiratory distress syndrome (RDS) by using LUS.From January 2013 to February 2014, 60 infants who were diagnosed with TTN based on medical history, clinical manifestations, arterial blood gas analysis, and chest radiography were recruited to the study group. During the same period, 40 hospitalized neonates with nonlung diseases and 20 patients with RDS were recruited to the control group. In a quiet state, infants were placed in the supine, lateral, or prone position for the examination. Each lung of every infant was divided into 3 regions: the anterior, lateral, and posterior regions as bordered by the anterior axillary and posterior axillary lines. The probe was placed perpendicular to the ribs. Each region of both the lungs was carefully scanned.The common ultrasonographic manifestations of TTN were double-lung point (DLP), interstitial syndromes or white lungs, pleural line abnormalities, and A-line disappearance. A small number of infants (20%) with TTN exhibited pleural effusions, whereas the main ultrasonographic manifestation of RDS was lung consolidation with air bronchograms, which does not occur in TTN. The sensitivity and specificity of DLP for the diagnosis of TTN were 76.7% and 100%, respectively.LUS can accurately and reliably diagnose TTN. The DLP and lung consolidation possess great value in the diagnosis and differential diagnosis of TTN with RDS. Thus, we believe that LUS can be widely used in neonatal intensive care units.

To completely compare the risk factors, respiratory therapies and complications between respiratory distress syndrome (RDS) and transient tachypnea of newborn (TTN) in preterm infants. Data were collected from preterm infants in Department of NICU, Peking University Third Hospital from January, 2013 to December, 2013. Components of clinical variables, including perinatal risk factors, ventilation therapies, pulmonary surfactant (PS) therapy, blood gas analysis and complications, were retrospectively analyzed. χ² test or Fisher's test or t test were used. Ninety-nine preterm infants mean gestational age was (31.9 ± 2.2) weeks and birth weight was (1 661 ± 501) g . Sixty-nine infants were diagnosed with TTN and 30 were diagnosed with RDS. There were significant differences in gestational age ((29.5 ± 2.5) vs. (32.0 ± 3.2) weeks, t = 6.046, P = 0.002), birth weight ((1 115 ± 415) vs. (1 660 ± 531) g, t = 5.916, P = 0.001). Nine cases in the RDS group had Apgar score ≤ 7 while four cases in the TTN group had Apgar score ≤ 7 (P = 0.001). Fourteen cases in RDS group were born through C-section while 55 cases of TTN group were born through C-section (P = 0.025). During 0-2 hours after birth, pH (7.25 ± 0.09 vs. 7.30 ± 0.01, t = -2.144, P = 0.046) was significantly lower in the RDS group. PaO₂((55 ± 20) vs. (41 ± 2) mmHg, 1 mmHg = 0.133 kPa, t = 2.963, P = 0.001) and oxigination index (OI) ((149 ± 58) vs.(100 ± 9) mmHg, t = 3.379, P = 0.003) were significantly lower in the TTN group. In the RDS group, all cases received PS therapy. Twenty-five cases received mechanical ventilation and five cases received noninvasive ventilation. In the TTN group, 12 cases received PS therapy. Forty-four cases received noninvasive ventilation and 25 cases received oxygen inhalation. The cases developing complications, including ventilator associated pneumonia (14(46.7%) vs.4(5.8%), P = 0.038), patent ductus arteriosus (19(63.3%) vs. 9(13.0%), P = 0.025), intraventricular hemorrhage (9(30.0%) vs. 2(2.9%), P = 0.041), bronchopulmonary dysplasia (12(40.0%) vs. 5(7.2%), P = 0.019), were significantly more in the RDS group. RDS and TTN are common causes leading to early dyspnea in preterm infants. Preterm infants with RDS are characterized by younger gestational age, lower birth weight, severer acidosis and more complications. Preterm infants with TTN show lower hypoxemia and OI.

Background Late preterm infants (LPIs) account for most preterm births and are at high risk of developing prematurity-related morbidities. Due to the increasing rate of cesarean section delivery, it is expected that more LPIs with respiratory complications will be admitted to neonatal intensive care units (NICU). Objectives To assess the rate of NICU admission and respiratory complications among LPIs and to compare their outcomes based on the mode of delivery. Patients and Methods The list of all LPIs who were admitted in the period 2015–2020 was reviewed. Data collected about demographic characteristics, delivery information, NICU admission, respiratory complications, respiratory support, length of stay, and readmission. Infants were classified according to their mode of delivery into: vaginal delivery group (VD) and cesarean section group (CS). Results Out of 2236 LPIs included, 321 (14%) were born at 34-week gestation, 1137 (51%) were males. 1243 (56%) were admitted to NICU. The CS group comprised 77% (1719) while the VD group 23% (517). Compared to the VD group, infants in the CS group had a higher rate of NICU admission (57.1% vs. 50.7%, P = 0.006), respiratory distress syndrome (RDS) (22% vs. 17%, P = 0.000), and transient tachypnea of newborn (TTN) (17% vs. 11%, P = 0.019). Also, more babies in the CS group received CPAP (36.2% vs. 24.6%, P = 0.000) and surfactant therapy (6.6% vs. 4.6%, P = 0.02). After logistic regression analysis, CS remains an independent factor for NICU admission (OR 1.3, 95% confidence intervals [CI] 1.1–1.6, P = 0.01), respiratory complications (OR 1.6, 95% CI 1.2–2.2, P = 0.001), CPAP requirement (OR 1.6, 95% CI 1.3–2, P = 0.000), and a longer length of stay > 3 days (OR 1.5, 95% CI 1.2–1.8, P = 0.000). Conclusion The rate of CS delivery among late preterm gestation is very high and alarming. CS delivery of LPI increases the rate of NICU admission, respiratory complications, and the need for respiratory support.

In view of the increasing rates of elective cesarean delivery in Western countries, occasioned chiefly by previous cesarean delivery or breech presentation, this study was designed to compare rates of respiratory distresssyndrome (RDS) and transient tachypnea of the newborn (TTN) in infants delivered electively at term during each week of gestation between 37 + 0 and 41 + 6 weeks gestation. Control women who delivered vaginally were matched with the study group for week of gestation. Elective cesarean deliveries at or after 37 + 0 weeks gestation totalled 1284, representing 13% of live births during the years 1998 to 2000. Previous section delivery accounted for approximately half the elective cesarean deliveries at term and breech presentation for approximately one fourth. The incidence of RDS after elective cesarean delivery at term and after vaginal delivery were, respectively, 22 and 4 per 1000; the incidence of TTN after elective cesarean delivery at term and after vaginal delivery were respectively 9 and 8.5 per 1000 deliveries. Compared with vaginal births, infants delivered by elective section had a significant and progressive reduction in neonatal RDS, but there were no significant differences in TTN related to mode of delivery. The odds ratio (OR) for total neonatal respiratory morbidity in the elective cesarean group, compared with the vaginal delivery group, was 2.6. The OR for TTN in the cesarean group was only 1.19, but the risk of RDS increased significantly (OR, 5.85) and peaked in weeks 37 + 0 to 38 + 6 (OR, 12.9). There was no significant difference in RDS risk beyond 39 + 0 weeks. There were no neonatal deaths in this study. In this population lacking prenatally identified risk factors, elective cesarean delivery at term was associated with more neonatal respiratory morbidity than was vaginal delivery. Less morbidity may be expected by waiting until week 39 + 0 before performing elective cesarean deliveries.

Objective To evaluate the diagnostic value of lung ultrasonography for transient tachypnea of newborn (TTN). Methods From January to December 2014, a total of 1 358 children were hospitalized in the Neonatal Intensive Care Center and underwent lung ultrasonography at the Bayi Children's Hospital, Beijing Military General Hospital.According to the patients' medical histories, clinical presentations, arterial blood gas analysis, chest X-ray examinations, and lung ultrasound examinations, there were 412 cases of patients without pulmonary lesions, 228 cases of TTN, 358 cases of respiratory distress syndrome (RDS), 85 cases of meconium aspiration syndrome (MAS), 215 cases of infectious pneumonia, and 60 other cases at the time of hospital admission.In a resting state, the patients were placed in a supine, lateral recumbent or prone position.By using the anterior and posterior axillary lines as boundaries, the lung was divided into 3 regions: anterior, lateral, and posterior.The probe was perpendicular or parallel to the ribs, and each region of both sides of the lung was scanned.The scan results were compared to the conventional chest X-ray results. Results The main ultrasonic characteristics of TTN was pulmonary edema.In severe cases, the ultrasound showed a white lung or compact B-line.Compact B-line had 100.0% sensitivity and 95.3% specificity for diagnosing severe TTN.Mild TTN presented as pulmonary interstitial syndrome or double lung point.Double lung point might appear during the recovery period of mild TTN or other diseases, such as RDS, MAS, and pneumonia, among others.Lung consolidation and air bronchogram were not observed in patients with TTN.Pleural effusion might occur in a variety of lung diseases, and pleural line abnormality, A-line disappearance, and B-line or pulmonary interstitial syndrome were common ultrasonic manifestations of a variety of lung diseases. Conclusions Ultrasonic diagnosis of TTN, mainly based on pulmonary edema without lung consolidation and air bronchogram, is accuracy and reliable; however, double lung point is not a specific sign of TTN, whereas the identification of a white lung and compact B-line is a sensitive and specific sign of severe TTN. Key words: Transient tachypnea; Lung ultrasound; Infant, newborn

To estimate the incidence of newborn respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in relation to gestational age and planned cesarean delivery in white, South Asian, and black women. Included in this study were 442,596 white, South Asian, and black women who delivered single live infants at 28 of weeks gestation onwards between 1988 and 2000. Using multiple logistic regression, the gestation-specific patterns of RDS for all deliveries and RDS plus TTN for deliveries by planned cesarean delivery were analyzed by racial group. The predictors of RDS from 37 weeks of gestation onwards were determined. More South Asians (28.2%, 95% confidence interval [CI] 27.8-28.6) and blacks (24.6%, 95% CI 24.0-25.1) delivered spontaneously before 39 weeks than whites (16.9%, 95% CI 16.8-17.1). Respiratory distress syndrome patterns by gestation differed significantly (P<.001). Compared with whites, the gestation-specific crude RDS rate was lower in South Asians up until 40 weeks and after adjusting for confounders; South Asians were most protected against RDS (odds ratio [OR] 0.6, 95% CI 0.5-0.9). The gestation-specific patterns of RDS plus TTN after planned cesarean delivery also differed significantly (P<.001) between racial groups. The lowest rate of TTN plus RDS was at 40 weeks for whites, but in South Asians and blacks, it was lowest at 38 weeks. The gestation-specific patterns of RDS differed significantly by racial group from 32 weeks of gestation onwards. Preterm black infants had a lower rate of RDS when compared with whites; also, South Asians had the lowest rate of transient tachypnea until 38 weeks and the lowest rate of RDS until 40 weeks of gestation. The advantages of waiting until 39 weeks to perform planned cesarean delivery for white women are not seen in South Asians or blacks.

The purpose of this study is to predict the occurrence of transient tachypnea of the newborn (TTN) using amniotic lamellar body count (LBC) and compare the LBCs in neonates with TTN with the LBCs in neonates with respiratory distress syndrome (RDS) and controls. Three hundred and eighty-one amniotic fluid samples were obtained at cesarean section from 27 to 40 weeks of gestation. Samples were analyzed immediately without centrifugation and the number of lamellar bodies was counted. The LBC in amniotic fluid ranged from 1,000 to 577,000/μL. An LBC cut-off value of 48,500/μL resulted in 84.7% sensitivity, 76.2% specificity, and 98.1% negative predictive value for predicting TTN. The LBC in neonates with TTN was significantly lower than that in controls (50,000 vs. 122,000; P<0.001) and significantly higher than that in neonates with RDS (50,000 vs. 21,000; P=0.042). We established a cut-off value of LBC for predicting the occurrence of TTN. The LBC in neonates with TTN was significantly lower than that in controls. Amniotic LBC can be a useful marker to predict if neonatal respiratory management is required.

To determine whether timing or type of delivery affects the incidence of transient tachypnea of the newborn (TTN) in late preterm and term pregnancies. The cases of 85 newborns delivered at Fatih University Hospital and diagnosed with TTN between January 2006 and March 2009 were reviewed. For every newborn with TTN, four infants who were not transferred to the neonatal intensive care unit (n = 340) were randomly selected and adjusted for year of delivery. Findings for delivery type (cesarean [CS] + labor, elective CS [ECS], vaginal), gestational age at delivery, and other relevant parameters were compared in the TTN and control groups. Forty-five (53%) of the 85 TTN newborns were premature and 73 (86%) were delivered by CS. Multivariate regression analysis identified male gender, CS delivery, lower gestational age, absence of PROM as risk factors for onset of TTN. In the CS + labor and ECS subgroups, the risk of TTN was significantly higher for babies delivered prior to 38 weeks' gestation than for those delivered at 38 weeks or later (OR = 8.13 and 95%CI = 3.58-18.52 vs. OR = 7.14 and 95%CI = 2.81-18.18, respectively; p < 0.001 for both). However, there was no increased risk of TTN in either of these subgroups when babies delivered at 38 weeks' gestation were compared with those delivered at ≥39 weeks (p > 0.05). At all gestational ages investigated in the study, infants delivered vaginally were less likely to develop TTN than those delivered via CS + labor or ECS. Lower gestational age, CS delivery, and male sex are independent risk factors for TTN. Performing ECS no earlier than 38 weeks' gestation may decrease the risk of TTN. Labor before CS is not sufficient to decrease the frequency of TTN, even after 37 weeks of gestation, whereas vaginal birth appears be protective against TTN.

Introduction Lung ultrasonography (LUS) has become frequently used in neonatal intensive care units (NICU) because it is diagnostic, useful, harmless, radiation-free, and practical for bedside use due to its portability. Objective This study aimed to evaluate the association between lung ultrasound (LUS) scores and diagnoses of neonates hospitalized for respiratory distress and determine the value of the combined use of laboratory and imaging methods in patient evaluation by looking at the correlation between blood gas parameters and LUS score. Materials and methods Between March and July 2022, a total of 55 patients who were born term or premature and admitted due to respiratory distress in the NICU of Malatya Training and Research Hospital were included in the study. In this observational, prospective study, demographic information such as birth weights, gestational weeks, mode of delivery, Apgar scores, blood gas sample results, LUS results and scores, ventilation types, and discharge time were recorded during hospitalization in our unit. According to the newborns' clinical, laboratory, and radiologic evaluations, the diagnoses of respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), or congenital pneumonia were made, and the relationship between the diagnoses and LUS scores was evaluated. The pH value and PCO2 value in the venous blood gas obtained on the day of LUS were recorded. Correlation analysis was performed between the LUS score and pH value, LUS score and PCO2 value. Results Twenty-seven newborns were diagnosed with TTN, 18 with RDS, and 10 with congenital pneumonia. There was a statistical difference between LUS scores and diagnoses (p<0.001). According to Spearman correlation analysis, a significant negative moderate correlation was found between LUS scores and venous blood gas pH value (p<0.001, r:-0.49). There was also a significant positive low, moderate correlation with venous blood gas PCO2 value (p<0.001, r:0.36). Conclusion This study demonstrates that LUS scoring has a role in determining the severity of disease and making diagnoses in patients hospitalized for respiratory distress. When LUS is widely used, it will be informative about the severity and prognosis of the disease, together with laboratory evaluation.

To determine whether antenatal corticosteroids administration prior to an elective cesarean section (ECS) at 34-37weeks gestation is associated with improved neonatal outcome. A case control study of women with singleton pregnancies who underwent ECS between 34 and 37weeks of gestation including two groups: (1) study group in which patients were treated with betamethasone prior to ECS (n=58) and (2) control group matched for gestational age at delivery in which patients did not receive betamethasone (n=107). Neonatal measures including respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), oxygen requirement, admission to the special care unit, hypoglycemia, hyperbilirubinemia and length of hospitalization were determined in both groups. Composite respiratory morbidity was defined as the presence of either RDS, TTN, mechanical ventilation or oxygen requirement. There was no significant difference in the rate of composite respiratory morbidity nor its components between patients with and without betamethasone treatment (25.9 vs. 25.2%, respectively, p=0.9). Antenatal treatment with corticosteroids prior to ECS at 34-37weeks of gestation did not result in significant reduction in neonatal respiratory morbidity in our cohort of patients.

Purpose Respiratory morbidity is the most common problem among neonates admitted to neonatal intensive care units. Therefore, the aim of this study was to make a differential diagnosis between transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), and pneumonia through comparison of clinical features and test results. Methods This retrospective study was conducted in 86 infants with TTN, RDS, or pneumonia. These were infants who had respiratory distress, were born after ≥34 weeks of gestation, and transferred to the neonatal intensive care unit of Kosin University Gospel Hospital between June 1, 2011 and June 30, 2016. Results The numbers (percentage) of infants with TTN, RDS, and pneumonia were 51 (59.3%), 20 (23.3%), and 15 (17.4%), respectively. Late-preterm and early-term newborns accounted for 65.1% of the infants. Tachypnea was observed in 74.4% of the neonates. The median age at admission was 4 hours (0 to 116) after birth. The infants with RDS had significantly lower birth weights, pH levels, base excess and oxygen saturation levels at admission, longer duration of total ventilator therapy, and hospital stay than those in the other two groups. The infants with pneumonia showed significantly high initial highsensitivity C-reactive protein levels and significant chest radiographic findings. Conclusion Early differential diagnosis for TTN, RDS, and pneumonia is challenging because they show similar respiratory symptoms at an early stage. Clinical features and test results can be used to determine the etiology of respiratory distress and early antibiotic treatment. Keywords: Etiology; Infant; Respiration disorders

Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn.

Transient tachypnea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD). However, distinguishing TTN from other causes of RD may be difficult during the first 12:24 h after birth. Lung ultrasonography (LUS) has been successfully utilized in the diagnosis and differential diagnosis of neonatal RD. This study aimed to investigate the diagnostic value of LUS for early diagnosis of TTN as well as differentiate it from other causes of neonatal RD in near and full term Egyptian neonates. LUS was performed in 65 near and full term neonates presented with RD within the first 12:24 hours of admission in NICU of Suez Canal University, Ismailia, Egypt. Among the 65 neonates included in the study, 73.8% were diagnosed to have TTN, 18.5% were diagnosed to have pneumonia, 4.6% had meconium aspiration syndrome (MAS) and 3.1% had respiratory distress syndrome (RDS). The Double lung point has 69.6% sensitivity, 100% specificity, 100% PPV and 39.1% NPV for detecting TTN. We have novel data showing a positive correlation between the degree of alveolar-interstitial syndrome (AIS) and the type of oxygen support offered to neonates diagnosed with TTN. We found LUS to be a reliable and non-invasive tool for the early diagnosis of TTN and its differentiation from other causes of neonatal RD in near and full term Egyptian neonates.

BackgroundCardiovascular and renal adaptation in neonates with Respiratory Distress Syndrome (RDS) and Transient Tachypnea of the Newborn (TTN) may be different.MethodsNeonates ≥32 weeks were diagnosed with RDS or TTN based on clinical, radiologic and lung sonographic criteria. Weight loss, feeding, urine output, and sodium levels were recorded for the first 3 days, and serial ultrasounds assessed central and organ Doppler blood flow. A linear mixed model was used to compare the two groups.ResultsTwenty-one neonates were included, 11 with TTN and 10 with RDS. Those with RDS showed less weight loss (− 2.8 +/− 2.7% versus − 5.6 +/− 3.4%), and less enteral feeds (79.2 vs 116 ml/kg/day) than those with TTN, despite similar fluid prescription. We found no difference in urine output, or serum sodium levels. Doppler parameters for any renal or central parameters were similar. However, Anterior Cerebral Artery maximum velocity was lower (p = 0.03), Superior Mesenteric Artery Resistance Index was higher in RDS, compared to TTN (p = 0.02).ConclusionIn cohort of moderately preterm to term neonates, those with RDS retained more fluid and were fed less on day 3 than those with TTN. While there were no renal or central blood flow differences, there were some cerebral and mesenteric perfusion differences which may account for different pathophysiology and management.

The aim of this study was to study the features of lung ultrasonography (LUS) in lung disease and to evaluate the usefulness of LUS in the neonatal intensive care unit (NICU).All of 3405 neonates included in this study underwent an LUS examination. Diagnoses were based on medical history, clinical manifestation, laboratory examination, and signs on chest radiography (CR) and/or computed tomography (CT). A single expert physician performed all LUS examinations.There were 2658 cases (78.9%) with lung disease and 747 cases (21.9%) without lung disease. The main signs of neonates with lung disease on LUS were as follows: absence of A-lines, pleural-line abnormalities, interstitial syndrome, lung consolidation, air bronchograms, pulmonary edema, and lung pulse. These abnormal signs were reduced or eliminated on LUS as patient conditions improved. There were 81 cases that could not be diagnosed as lung disease by CR but were discovered as pneumonia, respiratory distress syndrome (RDS), or transient tachypnea of newborn (TTN) on LUS. Likewise, 23 cases misdiagnosed as RDS by CR were diagnosed as TTN on LUS. Among 212 cases of long-term oxygen dependence (LTOD) that failed to yield signs of pulmonary edema and lung consolidation on CR, 103 cases showed abnormal signs on LUS. Among 747 cases without lung disease, B-lines of 713 neonates (95.4%) could be found within 3 days after birth, and 256 neonates (34.3%) could be observed from 3 days to 1 week after birth. B-lines of 19 cases could be detected from 1 to 2 weeks after birth. The longest time at which B-lines could still be observed was 19 days after birth.LUS has clinical value for the diagnosis of lung disease and the discrimination of causes of LTOP in premature infants, particularly for the diagnosis and identification of RDS and TTN. Moreover, LUS has additional advantages, including its lack of radiation exposure and its ability to noninvasively monitor treatment progress. Therefore, LUS should be routinely used in the NICU.