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Introduction: Lung ultrasound (LUS) has shown promise for evaluation of newborns with respiratory distress. However, no study has described the appearance of LUS during the initiation of breathing. We used LUS to describe the appearance of the lungs in healthy infants immediately after birth, starting with the infant's first breath, through the first 20min after birth.Methods: This was a single-center observational study enrolling neonates born at ≥35 weeks. We obtained LUS video recordings with the initiation of breathing. Recordings that captured one of the 1st four breaths after birth were included. We also obtained recordings at 1-10 and 11-20min after birth. Recordings were graded using a modified version of a previously published system, with additional grades to describe the appearance of the lungs prior to establishment of the pleural line.Results: We studied 63 infants, mean gestational age=391/7±2 days, mean weight=3473g±422, 33 infants were delivered vaginally and 30 via cesarean section. We captured the first breath after birth in 28 infants and within the first four breaths from the remaining 35 infants. The pleural line was established by a median of 4 breaths (3-6). At the 1-10min examination, all infants had an established pleural line and 89% demonstrated substantial liquid clearance. At the 11-20min examination, all infants had substantial liquid clearance.Conclusion: Establishment of the pleural line, indicating lung aeration and substantial liquid clearance is achieved with the first few breaths after birth in term and near term infants. [ABSTRACT FROM AUTHOR]

Background Cranial ultrasound cerebral biometric measurements have been used in preterm neonates, particularly in cases of ventriculomegaly. While cerebral biometric measures using MRI have been found to correlate with long-term outcome, the relationship between cranial ultrasound biometric measures and neurodevelopmental outcome has not been established. Objective To assess the relationship between ventricular size at 1 month of age using cranial ultrasound and neurodevelopmental outcome at 2 years in very preterm infants. Method Digital cranial ultrasound images taken between 25 and 35 days of age of 44 infants born at less than 30 weeks' gestation were analysed independently by two observers. Infants with significant ultrasound abnormalities were excluded. A range of ultrasound linear measures were correlated with Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) motor, language and cognitive composite scores at 2 years using linear regression. Results Larger lateral ventricular sizes (anterior horn width, ventricular height, midbody ventricular height) and larger ventricular-brain biparietal ratios were related to poorer motor composite score at 2 years. A ventricular-brain ratio of less than 0.3 was reassuring with regard to motor outcome. Poorer language composite scores at 2 years were associated with larger midbody ventricular heights. There was little evidence of a relationship with the cognitive composite score. Conclusions Larger lateral ventricles in the parietal region at a month of age were related to poorer motor development at 2 years. Larger ventricular measurements were also related to slower early language development. The role of cranial ultrasound biometric measures as biomarkers of later outcome in very preterm infants warrants further investigation. [ABSTRACT FROM AUTHOR]

Introduction: Early identification of infants requiring surfactant therapy improves outcomes. We evaluated the accuracy of delivery room lung ultrasound (LUS) to predict surfactant therapy in very- and extremely preterm infants.Methods: Infants born at <320/7 weeks were prospectively enrolled at 2 centres. LUS videos of both sides of the chest were obtained 5-10 min, 11-20 min, and 1-3 h after birth. Clinicians were masked to the results of the LUS assessment and surfactant therapy was provided according to local guidelines. LUS videos were graded blinded to clinical data. Presence of unilateral type 1 ('whiteout') LUS or worse was considered test positive. Receiver Operating Characteristic (ROC) analysis compared the accuracy of LUS and an FiO2 threshold of 0.3 to predict subsequent surfactant therapy.Results: Fifty-two infants with a median age of 276/7 weeks (IQR 260/7-286/7) were studied. Thirty infants (58%) received surfactant. Area under the ROC curve (AUC) for LUS at 5-10 min, 11-20 min and 1-3 h was 0.78 (95% CI, 0.66-0.90), 0.76 (95% CI, 0.65-0.88) and 0.86 (95% CI, 0.75-0.97) respectively, outperforming FiO2 at the 5-10 min timepoint (AUC 0.45, 95% CI 0.29-0.62, p = 0.001). At 11-20 min, LUS had a specificity of 95% (95% CI 77-100%) and sensitivity of 59% (95% CI, 39-77%) to predict surfactant therapy. All infants born at 23-276/7 weeks with LUS test positive received surfactant. Twenty-six infants (50%) had worsening of LUS grades on serial assessment.Conclusions: LUS in the delivery room and accurately predicts surfactant therapy in infants <320/7 weeks. [ABSTRACT FROM AUTHOR]