Neonatal Chest Research Articles

Factors Influencing ESD in NICUs and Adult Chest X-ray Examination in Bangladesh

Understanding the factors that influence Entrance Surface Dose (ESD) in neonatal and adult chest X-ray examinations is crucial for improving radiation safety. This study explores these influences, along with patterns in chest X-ray usage in Bangladesh, highlighting demographic trends, symptoms, and diagnostic outcomes. Conducted in a single hospital in Dhaka, the study assessed radiation doses in 150 adults and 150 neonates. Data collection involved using a 1000 mA X-ray machine for adults (aged 11-80 years) and a portable Medion MI 100 MOVX Mobile X-ray Machine for neonates (aged 1-20 days), with participants chosen through simple random sampling. X-ray exposure parameters (kVp and mAs) were recorded, and ESD (measured in milligrays) was calculated using a formula tailored for adults and neonates. The results showed a higher number of males (57.3%) than females (42.7%) seeking X-rays. The most common symptoms were fever (51.3%), cold and cough (32%), and chest pain (13.3%). Pulmonary inflammatory lesions were observed in 13.3% of cases, with pleural effusion and cardiomegaly present in 8% and 6.7% of patients, respectively, while 72% had normal findings. There was a noticeable link between certain symptoms and diagnoses, such as chest pain correlating with cardiomegaly and fever with pulmonary inflammatory lesions. ESD levels generally increased with age, though there was a slight decrease in the 51-60 age group. These findings provide valuable insights into chest X-ray practices, which could guide better patient care and targeted interventions in Bangladesh.

Correlation of cardiotocography with combined APGAR scores and diagnostic performance of umbilical cord parameters in predicting low combined APGAR scores – A prospective Cohort study

ObjectivesCombined Apgar score includes utilization of interventions such as Continuous positive airway pressure, Oxygen, Mask and Bag ventilation, I ntubation and ventilation, Ne onatal chest compression, Drugs, and newborn assessment. It has been proposed as a substitute for conventional Apgar score which is the gold standard for evaluating newborns right after birth but is impacted by medical interventions and preterm. Combined Apgar scores were examined to check for correlation with CTG tracing and umbilical cord blood parameters which gives an objective assessment of fetal hypoxia, in response to the demand for a more accurate tool for evaluating the neonate and to be used for medico-legal purposes. The study's objectives were to (1) determine the association of combined Apgar scores with suspicious and pathological CTG (2) the association of umbilical cord parameters with low combined Apgar scores and the diagnostic performance of these parameters in predicting low combined Apgar scores. Study designA prospective observational cohort study was conducted in a tertiary care center in East India. 2350 consecutive laboring mothers who had completed 34 weeks of gestation underwent cardiotocography according to institutional protocol and those with suspicious and pathological CTG who delivered within 1 h of abnormal CTG were recruited. Arterial blood was analyzed and the newborn was evaluated immediately after delivery with a combined Apgar scoring system ResultsOf the 2350 women, 50.7 % and 49.3 %, respectively, exhibited suspicious and abnormal CTG tracings. CTG was reported to have low diagnostic accuracy and specificity, with a sensitivity of 66.7 % and 88.9 %, respectively, in detecting combined Apgar at 1 and 5 min. The combined Apgar score at five minutes showed a strong association with acidosis. There was a statistically significant correlation between low combined Apgar and excess lactate and base at one and five minutes. With 100 % sensitivity and 95 % specificity, high lactate levels > 4.1 mM/L were found to predict newborn encephalopathy. ConclusionUmbilical cord blood parameters were found to be correlated with low combined Apgar scores. Combined Apgar scores may be a more useful tool for neonatal assessment and long-term morbidity of newborns. Additional research is required to determine whether it can take the role of conventional Apgar scores in clinical practice.

Relationship between neonatal respiratory distress syndrome pulmonary ultrasonography and respiratory distress score, oxygenation index, and chest radiography grading.

Accurate condition assessment is critical for improving the prognosis of neonatal respiratory distress syndrome (RDS), but current assessment methods for RDS pose a cumulative risk of harm to neonates. Thus, a less harmful method for assessing the health of neonates with RDS is needed. To analyze the relationships between pulmonary ultrasonography and respiratory distress scores, oxygenation index, and chest X-ray grade of neonatal RDS to identify predictors of neonatal RDS severity. This retrospective study analyzed the medical information of 73 neonates with RDS admitted to the neonatal intensive care unit of Liupanshui Maternal and Child Care Service Center between April and December 2022. The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray grade of each newborn before and after treatment were collected. Spearman correlation analysis was performed to determine the relationships among these values and neonatal RDS severity. The pulmonary ultrasonography score, respiratory distress score, oxygenation index, and chest X-ray RDS grade of the neonates were significantly lower after treatment than before treatment (P < 0.05). Spearman correlation analysis showed that before and after treatment, the pulmonary ultrasonography score of neonates with RDS was positively correlated with the respiratory distress score, oxygenation index, and chest X-ray grade (ρ = 0.429-0.859, P < 0.05). Receiver operating characteristic curve analysis indicated that pulmonary ultrasonography screening effectively predicted the severity of neonatal RDS (area under the curve = 0.805-1.000, P < 0.05). The pulmonary ultrasonography score was significantly associated with the neonatal RDS score, oxygenation index, and chest X-ray grade. The pulmonary ultrasonography score was an effective predictor of neonatal RDS severity.

Prenatal exposure to benzophenone-type UV filters and the associations with neonatal birth outcomes and maternal health in south China

Benzophenone (BP)-type UV filters are commonly added to sunscreens and cosmetics to protect against UV radiation for human skin and hair. As a result, BPs are ubiquitous in the environment and human body, and their endocrine-disrupting characteristics have been a hot topic of discussion. However, our knowledge regarding the detrimental effects of prenatal exposure to BPs on pregnant women and their offspring remains limited. To fill this gap, we determined five BP derivatives in 600 serum samples obtained from pregnant women. All the target analytes, except 2,4-dihydroxybenzophenone (BP-1), have achieved a 100 % detection rate. The most prevalent compound was 2-hydroxy-4-methoxybenzophenone (BP-3), with a median concentration of 0.545 ng/mL. Significant and positive correlations were observed among BP derivatives, indicating both endogenous metabolism and common external sources. Utilizing Bayesian kernel machine regression (BKMR) and quantile-based g-computation (QGC) models, we found relationships between BP exposure and reduced neonatal birth weight (BW) and birth chest circumference (BC) during the third trimester. Notably, the adverse effect of BPs on birth size was sex-specific. Moreover, triglyceride (TG) was identified as a potential mediator of the effect of BPs on blood pressure, and co-exposure to BPs was linked to disruptions in thyroid hormone levels and glucose regulation. Further research is warranted to unravel the toxicity of BPs and their detrimental effects on pregnant women and fetuses.

Radiographic Evaluation of Neonatal Respiratory Distress: Cross-Sectional Study on Chest X-ray Findings in the Neonatal Intensive Care Unit

Introduction: Neonatal Respiratory distress (NRD) is a common reason for admission to the Neonatal Intensive Care Unit (NICU). While clinical diagnosis is essential, imaging evaluation can help confirm lung lesions, their extent, and associated abnormalities. However, radiation exposure from imaging modalities such as Computed Tomography (CT) and Chest X-ray (CXR) is a concern, particularly for neonates. This study aims to identify the various CXR findings in neonates with respiratory distress in the NICU. Methods: A quantitative cross-sectional study was conducted on 59 neonates with respiratory distress in the NICU from November 2019 to November 2020. Ethical clearance was obtained, and data were collected through portable CXR. The collected data were analyzed using Microsoft Excel 2016 and Statistical Package of Social Services (SPSS) IBM version 23. Results: CXR findings of 59 neonates with a mean age of 15.9 ± 7.4 days were evaluated. The majority were premature neonates, and the most common clinical diagnosis was respiratory distress syndrome (RDS). Hypoaeration was the most common finding in lung fields, followed by normal aeration. Parenchymal changes were observed in most cases, with reticulations/haziness being the most common, followed by consolidation. Pleural effusion was seen in a few cases, predominantly in preterm neonates with RDS. Conclusions: The study underscores the prevalence of hypoaeration, reticulations, and consolidations in NICU patients with RDS, emphasizing the importance of early diagnosis and future research in neonatal chest imaging for respiratory distress.

NeoSSNet: Real-Time Neonatal Chest Sound Separation Using Deep Learning.

Goal: Auscultation for neonates is a simple and non-invasive method of diagnosing cardiovascular and respiratory disease. However, obtaining high-quality chest sounds containing only heart or lung sounds is non-trivial. Hence, this study introduces a new deep-learning model named NeoSSNet and evaluates its performance in neonatal chest sound separation with previous methods. Methods: We propose a masked-based architecture similar to Conv-TasNet. The encoder and decoder consist of 1D convolution and 1D transposed convolution, while the mask generator consists of a convolution and transformer architecture. The input chest sounds were first encoded as a sequence of tokens using 1D convolution. The tokens were then passed to the mask generator to generate two masks, one for heart sounds and one for lung sounds. Each mask is then applied to the input token sequence. Lastly, the tokens are converted back to waveforms using 1D transposed convolution. Results: Our proposed model showed superior results compared to the previous methods based on objective distortion measures, ranging from a 2.01 dB improvement to a 5.06 dB improvement. The proposed model is also significantly faster than the previous methods, with at least a 17-time improvement. Conclusions: The proposed model could be a suitable preprocessing step for any health monitoring system where only the heart sound or lung sound is desired.

Neonatal and Infant Lung Disorders

A multitude of lung disorders ranging from congenital and genetic anomalies to iatrogenic complications can affect the neonate or the infant within the first year of life. Neonatal and infant chest imaging, predominantly by plain radiography and computed tomography, is frequently employed to aid in diagnosis and management; however, these disorders can be challenging to differentiate due to their broad-ranging, and frequently overlapping radiographic features. A systematic and practical approach to imaging interpretation which includes recognition of radiologic patterns, utilization of commonly accepted nomenclature and classification, as well as interpretation of imaging findings in conjunction with clinical history can not only assist radiologists to suggest the diagnosis, but also aid clinicians in management planning. The contents of this article were endorsed by the leadership of both the World Federation of Pediatric Imaging (WFPI), and the International Society of Pediatric Thoracic Imaging (ISPTI).

Effects of valproic acid on syncytialization in human placental trophoblast cell lines

The placenta is a critical organ for fetal development and a healthy pregnancy, and has multifaceted functions (e.g., substance exchange and hormone secretion). Syncytialization of trophoblasts is important for maintaining placental functions. Epilepsy is one of the most common neurological conditions worldwide. Therefore, this study aimed to reveal the influence of antiepileptic drugs, including valproic acid (VPA), carbamazepine, lamotrigine, gabapentin, levetiracetam, topiramate, lacosamide, and clobazam, at clinically relevant concentrations on syncytialization using in vitro models of trophoblasts. To induce differentiation into syncytiotrophoblast-like cells, BeWo cells were treated with forskolin. Exposure to VPA was found to dose-dependently influence syncytialization-associated genes (ERVW-1, ERVFRD-1, GJA1, CGB, CSH, SLC1A5, and ABCC4) in differentiated BeWo cells. Herein, the biomarkers between differentiated BeWo cells and the human trophoblast stem model (TSCT) were compared. In particular, MFSD2A levels were low in BeWo cells but abundant in TSCT cells. VPA exposure affected the expression of ERVW-1, ERVFRD-1, GJA1, CSH, MFSD2A, and ABCC4 in differentiated cells (ST-TSCT). Furthermore, VPA exposure attenuated BeWo and TSCT cell fusion. Finally, the relationships between neonatal/placental parameters and the expression of syncytialization markers in human term placentas were analyzed. MFSD2A expression was positively correlated with neonatal body weight, head circumference, chest circumference, and placental weight. Our findings have important implications for better understanding the mechanisms of toxicity of antiepileptic drugs and predicting the risks to placental and fetal development.

Establishing weight-based diagnostic reference levels for neonatal chest X-rays

IntroductionAs weights among neonates can vary from <900 g to >2.5 kg, weight-based Diagnostic Reference Levels (DRLs) specific to the neonatal intensive care unit (NICU) are essential. Repeated radiation exposure to this sensitive patient group raises concerns regarding high cumulative radiation doses and the potential for long-term health detriment. This study aimed to establish weight-based DRLs for neonates undergoing mobile chest radiography (CXR) in the NICU. MethodsNeonates were classified into three discrete groups; <1000, 1000–2500 and >2500 g. Data were collected prospectively over three months; 95 DAP values were collected, and five were excluded due to poor technique, leaving 90 patients that met the inclusion criteria for mobile CXR in the NICU. Dose-area-product (DAP) in mGycm2, the peak kilovoltage (kVp) and the product of tube current and exposure time (mAs) were retrieved from the Picture Archiving and Communication System (PACS). Images and radiological reports were also analysed to confirm diagnostic image quality (IQ). Local DRLs (LDRLs) were derived using the median DAP, and national DRLs were suggested using the 3rd quartile value. ResultsThe proposed LDRLs for neonates weighing <1000 g was 2.7 mGycm2, for neonates weighing between 1000 g and 2500 g, it was 3.7 mGycm2, and for neonates weighing >2500 g it was 6.6 mGycm2. The radiation dose received by the 90 (100%) neonates included in the study fell below 11.4 mGycm2; of these, 82% of the DAP values fell below the study institution's existing LDRL of 7.25 mGycm2. ConclusionWeight-based DRLs provide crucial information on doses to this specific radiation-sensitive group. This work recommends using weight-based categories for DRLs and serves as a benchmark for neonatal CXR standardisation and optimisation. Implications for practiceThe proposed weight-based DRLs can be adopted for neonates’ locally, nationally and internationally.

Noisy Neonatal Chest Sound Separation for High-Quality Heart and Lung Sounds.

Stethoscope-recorded chest sounds provide the opportunity for remote cardio-respiratory health monitoring of neonates. However, reliable monitoring requires high-quality heart and lung sounds. This paper presents novel artificial intelligence-based Non-negative Matrix Factorisation (NMF) and Non-negative Matrix Co-Factorisation (NMCF) methods for neonatal chest sound separation. To assess these methods and compare them with existing single-channel separation methods, an artificial mixture dataset was generated comprising heart, lung, and noise sounds. Signal-to-noise ratios were then calculated for these artificial mixtures. These methods were also tested on real-world noisy neonatal chest sounds and assessed based on vital sign estimation error, and a signal quality score of 1-5, developed in our previous works. Overall, both the proposed NMF and NMCF methods outperform the next best existing method by 2.7dB to 11.6dB for the artificial dataset, and 0.40 to 1.12 signal quality improvement for the real-world dataset. The median processing time for the sound separation of a 10s recording was found to be 28.3s for NMCF and 342ms for NMF. With the stable and robust performance of our proposed methods, we believe these methods are useful to denoise neonatal heart and lung sounds in the real-world environment. Codes for proposed and existing methods can be found at: https://github.com/egrooby-monash/Heart-and-Lung-Sound-Separation.

Neonatal heart rate monitoring at birth with hands-free foetal doppler

There is a need for improved measurement and documentation of the neonatal heart rate immediately after birth, which currently relies on auscultation with a stethoscope. Measurement of the heart rate is a medical requirement within the first minute after birth in all babies. Heart rate at birth is the only reliable indicator of the health of the neonate which does not establish breathing immediately. In sick neonates pulse oximetry is usually available but does not provide an output for the first minute even in healthy neonates. Although the ECG is considered the gold standard, it may provide a false measurement due to pulseless electrical activity of the myocardium. Neonatal ECG technology is not routinely available at birth, however prior to birth the fetal heart rate is routinely obtained and documented by a low cost doppler ultrasound. Recently the fetal doppler has been shown to be effective immediately after birth on the neonatal chest (Hutchon 2022) but requires constant attention by the carer, and may interfere with measures to provide positive pressure ventilation or other resuscitation measures. A fetal doppler ultrasound device has been extended to provide a hands free sensor which is secured on the neonatal chest by the surface tension of the transducer gel. The system also works well through polythene and provides a safe and effective neonatal heart rate monitor inside a sterile polythene bag for use at caesarean birth. The design features are presented and preliminary data showing the precordial doppler provides a heart rate closely equivalent to the heart rate from the gold standard ECG.

Effects of Patient Recumbency Position on Neonatal Chest EIT

Effects of Patient Recumbency Position on Neonatal Chest EIT

Ampliando a aplicabilidade da ultrassonografia no âmbito neonatal: além das hemorragias cerebrais

ABSTRACT Introduction: Neonatal ultrasound began in the 1970s to evaluate cerebral hemorrhages. With the advent of different transducers and improvement of the technological devices (Doppler function), its use has greatly expanded, being possible the evaluation many organs. Objectives: The study aims to show new applicability of ultrasonography, as an auxiliary method in the diagnosis of spinal alterations, pulmonary diseases, and cranial sutures in the neonatal period. Methods: Descriptive study of ultrasound examinations performed with the Logiq P7 device of General EletricT, with multifrequency and microconvex transducers with frequency of 3 to 11 MHz and linear with frequency of 2 to 11 MHz. Ultrasound evaluations were performed immediately after diagnostic suspicion, by a specialist physician with more than 15 years of experience in pediatric ultrasound, provided that the clinical condition of the newborn allowed the examination and, if there was a need, a new ultrasound would be performed for diagnostic confirmation. Residência Pediátrica; 2023: Ahead of Print DOI: 10.25060/residpediatr-2023-836 Nota aos leitores: pode haver informações pendentes, por se tratar de um artigo em “visualização pré-publicação”. Results: Presentation of ultrasound images performed routinely in a neonatal tertiary-level unit, including evaluations of spine, lungs and skull bones presented as well: 1.Ultrasonography of normal neonatal spine (medullary cone and cauda equina). 2.Normal neonatal chest ultrasound, with the presence of A-lines and rare B-lines, and graphic representation of normal diaphragmatic mobility. 3.Ultrasound of the pervious and closed sagittal cranial suture. Conclusions: Ultrasonography has several applicability, and its use in the neonatal population favors satisfactory the diagnosis and follow-up of various pathologies, in a noninvasive and innocuous manner, reserving the other diagnostic methods for cases in which diagnostic complementation is necessary.

Ampliando a aplicabilidade da ultrassonografia na esfera neonatal: além das hemorragias cerebrais

INTRODUCTION: Neonatal ultrasound began in the 1970s to evaluate cerebral hemorrhages. With the advent of different transducers and improvement of the technological devices (Doppler function), its use has greatly expanded, being possible the evaluation many organs. OBJECTIVES: The study aims to show new applicability of ultrasonography, as an auxiliary method in the diagnosis of spinal alterations, pulmonary diseases, and cranial sutures in the neonatal period. METHODS: Descriptive study of ultrasound examinations performed with the Logiq P7 device of General EletricT, with multifrequency and microconvex transducers with frequency of 3 to 11 MHz and linear with frequency of 2 to 11 MHz. Ultrasound evaluations were performed immediately after diagnostic suspicion, by a specialist physician with more than 15 years of experience in pediatric ultrasound, provided that the clinical condition of the newborn allowed the examination and, if there was a need, a new ultrasound would be performed for diagnostic confirmation. RESULTS: Presentation of ultrasound images performed routinely in a neonatal tertiary-level unit, including evaluations of spine, lungs and skull bones presented as well: 1. Ultrasonography of normal neonatal spine (medullary cone and cauda equina). 2. Normal neonatal chest ultrasound, with the presence of A-lines and rare B-lines, and graphic representation of normal diaphragmatic mobility. 3. Ultrasound of the pervious and closed sagittal cranial suture. CONCLUSIONS: Ultrasonography has several applicability, and its use in the neonatal population favors satisfactory the diagnosis and follow-up of various pathologies, in a noninvasive and innocuous manner, reserving the other diagnostic methods for cases in which diagnostic complementation is necessary.

Abstract 04: Chest Compressions Superimposed With Sustained Inflations Compared to Continuous Chest Compressions with Asynchronized Ventilation During Cardiopulmonary Resuscitation in Asphyxiated Pediatric Piglets - A Randomized Controlled Animal Study

Introduction: Respiratory arrest is the leading cause of pediatric cardiac arrest. Pediatric CRP guidelines therefore focus on respiratory support during CPR, but the optimal approach to oxygen delivery and coronary perfusion during pediatric CPR is not known. Animal studies reported that chest compressions superimposed with constant high distending pressure, or sustained inflation (CC+SI), significantly reduces time to return of spontaneous circulation (ROSC) compared to 3:1 chest compression:ventilation in neonatal piglets or chest compressions with asynchronous ventilation (CCaV) in pediatric piglets. During CC+SI, both cardiovascular and respiratory parameters were improved, which resulted in the faster time to ROSC. Hypothesis: In the current study, we hypothesized that CC+SI, compared to CCaV, would reduce time to ROSC in pediatric piglets with asphyxia-induced cardiac arrest. Methods: Twenty-eight pediatric piglets (21-24 days old, 7.5-9.2 kg) were anesthetized, intubated, instrumented, and exposed to 30 min normocapnic hypoxia followed by asphyxia. Piglets were then randomized to, and received, either CC+SI or CCaV for resuscitation (n=14 per group). Resuscitative efforts were continued until ROSC was achieved, or up to a maximum of 10 min. Hemodynamic parameters were monitored throughout the experiment and up to 30 min post-ROSC. Results and Conclusions: Overall, the mean (SD) time to ROSC was 208 (190) sec with CC+SI and 388 (258) sec with CCaV (p=0.045) (Table 1). There was a 100% increase in the number of piglets achieving ROSC with CC+SI compared to CCaV (CC+SI n=12 versus CCaV n=6, p=0.046). Median minute ventilation in the CC+SI group was 2,315 mL/min compared with 354 mL/min in the CCaV group (p=0.0001). Both systolic and diastolic blood pressure were higher in the CC+SI group, compared to the CCaV group throughout resuscitation. In summary, CC+SI improved time to ROSC and increased the number of piglets achieving ROSC. There was significantly higher minute ventilation with CC+SI, compared to CCaV, and both systolic and diastolic blood pressure were higher throughout resuscitation with CC+SI compared to CCaV. Studies in pediatric patients using CC+SI are warranted.

Relationship between the visual evaluation of pathology visibility and the physical measure of low contrast detail detectability in neonatal chest radiography

IntroductionThe detectability of low contrast detail (LCD) is a method used to assess image quality (IQ) in neonatal radiography; however, there is a lack of data on the relationship between LCD detectability and visual IQ. The study aims at investigating the relationship between the LCD detectability and visual IQ and pathology visibility (PV). MethodsSeveral acquisition parameters were employed to obtain a group of images from a neonatal Gammex chest phantom. Three observers applied relative visual grading analysis (VGA) for assessing the IQ and PV. A simulated pneumothorax visibility (PNV) and simulated hyaline membrane disease visibility (HMV) represented PV. Next, a CDRAD 2.0 phantom was radiographed utilising the same acquisition protocols, and several paired images were obtained. With the use of CDRAD analyser software, the detectability of LCD was assessed and expressed by an image quality figure inverse (IQFiinv) metric. The correlation between the IQFinv and each of IQ, PNV and HMV was examined. ResultsThe physical measure (IQFinv) and the visual assessment of IQ were shown to be strongly correlated (r = 0.95; p < 0.001). Using Pearson's correlation, the IQFinv, PNV, and HMV were found to be strongly correlated (r = 0.94; p < 0.001) and (r = 0.92; p < 0.001), correspondingly. ConclusionResults of the study show that physical measures of LCD detectability utilising the CDRAD 2.0 phantom is strongly corelated with visual IQ and PV (PNV and HMV) and can be used to evaluate IQ when undertaking neonatal chest radiography (CXR). Implications for practiceThis study establishes the feasibility of utilising the physical measure (IQFinv) and the CDRAD 2.0 phantom in routine quality assurance and neonatal CXR optimisation studies.

A phantom study of a protective trolley for neonatal radiographic imaging: new equipment to protect the operator from scatter radiation.

Chest radiography is commonly performed as a diagnostic tool of neonatal diseases. Contact-based radiation personal protective equipment (RPPE) has been widely used for radiation protection, but it does not provide full body protection and it is often shared between users, which has become a major concern during the coronavirus disease 2019 (COVID-19) pandemic. To address these issues, we developed a novel trolley to protect radiographers against X-ray radiation by reducing scatter radiation during neonatal radiographic examinations. We measured the scatter radiation doses from a standard neonatal chest radiograph to the radiosensitive organs using a phantom operator in three protection scenarios (trolley, radiation personal protective equipment [RPPE], no protection) and at three distances. The results showed that the scatter radiation surface doses were significantly reduced when using the trolley compared with RPPE and with no protection at a short distance (P<0.05 for both scenarios in all radiosensitive organs). The novel protective trolley provides a non-contact protective tool for radiographers against the hazard of scatter radiation during neonatal radiography examinations.

Neonatal Resuscitation

The resuscitation of a neonate in the emergency department is an infrequent occurrence. As such, it is imperative that emergency physicians are aware of the resources available at their institution in the event that resuscitation arises. The two mainstays of neonatal resuscitation are respiration and temperature. When resuscitation is required, it is due to a respiratory cause in the majority of neonates. Therefore, if the airway and breathing are managed properly, the heart rate and overall neonatal status will follow suit. Should the neonate’s heart rate continue to be below 60 beats per minute, then he or she will need chest compressions in addition to respiratory support. During the transition from intrauterine life to extrauterine life, neonates stand to lose substantial amounts of heat. Therefore, the temperature of the neonate also needs to be actively managed to prevent the loss of heat. The resuscitation will eventually end in one of two pathways: the termination of efforts or the successful resuscitation of the neonate. If the resuscitation is successful, the proper admission or transfer will need to be arranged for definitive care for the neonate. Figures include the review of fetal and neonatal circulation, proper use of equipment, and proper chest compression technique. Tables include equipment needed, Apgar scores, normal neonatal vital signs, disposition, and neonatal intensive care unit levels. Key words: Apgar scores, fetal circulation, neonatal chest compressions, neonatal circulation, neonatal resuscitation, neonatal intensive care unit levels

Clinical Management of Neonatal Pneumothorax using Improvised Chest Tube and Suction Machine in Delta State University Teaching Hospital, Nigeria

Neonatal pneumothorax occurs when air leaks into the pleural space. The appropriate size neonatal chest tube with its underwater seal is often not available in many institutions, so we improvise. We present a case report of the clinical management of a two day old male neonate with imperforate anus who had pneumothorax post colostomy creation and our improvised intervention using a size 3 endotracheal tube as our chest tube, 750 ml of water bottle as our underwater seal, and this connected to a suction machine for facilitated drainage of air from the pleural space. This case report is intended to provide an alternative method of intervention in areas where appropriately sized chest tubes underwater seal drainage systems are not available.

Neonatal digital chest radiography- should we be using additional copper filtration?

Copper filtration removes lower energy X-ray photons, which do not enhance image quality but would otherwise contribute to patient radiation dose. This study explores the use of additional copper filtration for neonatal mobile chest imaging. A controlled factorial-designed experiment was used to determine the effect of independent variables on image quality and radiation dose. These variables included: copper filtration (0 Cu, 0.1 Cu and 0.2 Cu), exposure factors, source-to-image distance and image receptor position (direct / tray). Image quality was evaluated using absolute visual grading analysis (VGA) and contrast-to-noise ratio (CNR) and entrance surface dose (ESD) was derived using an ionising chamber within the central X-ray beam. VGA, CNR and ESD significantly reduced (p < 0.01) when using added copper filtration. For 0.1 Cu, the percentage reduction was much greater for ESD (60%) than for VGA (14%) and CNR (20%), respectively. When compared to the optimal combinations of parameters for incubator imaging using no copper filtration, an increase in kV and mAs when using 0.1-mm Cu resulted in better image quality at the same radiation dose (direct) or, equal image quality at reduced dose (in-tray). The use of 0.1-mm Cu for neonatal chest imaging with a corresponding increase in kV and mAs is therefore recommended. Using additional copper filtration significantly reduces radiation dose (at increased mAs) without a detrimental effect on image quality. This is the first study, using an anthropomorphic phantom, to explore the use of additional Cu for digital radiography neonatal chest imaging and therefore helps inform practice to standardise and optimise this imaging examination.