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Purpose: To investigate the development of diaphragmatic dysfunction in ventilated extremely preterm infants (EPI) using diaphragm ultrasound (DU). Methods: EPI of less than 28 weeks’ gestational age who required mechanical ventilation within six hours of birth were included in this prospective, observational study. The DU was performed once a day until four days of life. End-inspiratory and end-expiratory thicknesses of the diaphragm were measured and the diaphragm thickening fraction was calculated. Results: A total of 20 EPI were enrolled. After intubation, there was a progressive reduction in end-inspiratory thicknesses of the diaphragm from baseline to day 1 (P < 0.001), but not from day 1 to day 2 (P = 0.078), day 2 to day 3 (P = 1.0), or day 3 to day 4 (P = 1.0). There was also a significant reduction in the diaphragm thickening fraction from baseline to day 1 (P < 0.001), but not from day 1 to day 2 (P = 1.0), day 2 to day 3 (P = 1.0), or day 3 to day 4 (P = 1.0). Conclusions: This study provides the first evidence of diaphragmatic dysfunction in ventilated EPI. We demonstrated a rapid progression of ventilator-induced diaphragmatic dysfunction, with a significant reduction in diaphragm thickness and thickening fraction within 24 hours of ventilation.

Objective To assess the impact of gravity and time on the changes in the distribution patterns of loss of aeration and atelectasis development in very preterm infants. Study design Preterm infants less than 32 weeks gestation were included in this prospective, observational study. Infants were assessed via serial lung ultrasound (LUS) score in four lung zones, performed on days 7, 14, 21, and 28 after birth. Result Eighty-eight patients were enrolled. There was a significant main effect of gravity (P

Background: Gravity affects the distribution of lung injuries due to gravity-induced nonhomogeneous ventilation leading to lung collapse and subsequently non-uniform lung lesions. Moreover, lung injury gradients gradually develop over time. However, changes in injury distribution after birth have not been investigated in very preterm infants. Methods: Preterm infants of less than 32 weeks’ gestational age were included in this prospective observational study. Gravity-dependent lungs (DL) were defined as dorsal lungs in a supine position or ventral lungs in a prone position, and non-dependent lungs (NDL) were defined as ventral lungs in a supine position or dorsal lungs in a prone position. Infants were assessed using lung ultrasound (LUS), which was performed on days 7, 14, 21, and 28 post-birth. Each anterior and posterior lung was scanned and received an LUS score of 0–3 points. LUS scores of the DL and NDL were compared. Total LUS scores were provided using a 0–6 point scale, which was obtained by adding the scores for each region of each lung. Results: Eighty–eight patients were enrolled in this study. On days 7, 14, and 21, LUS scores between the DL and NDL groups were significantly different (day 7, P = 0.01; day 14, P < 0.001; and day 21, P = 0.003). However, on day 28, there was no significant difference between groups (P = 0.064). Conclusions: LUS can be used to detect gravity-induced lung injury gradients in very preterm infants. Moreover, LUS revealed a trend of gradient improvement over time.

Background The purpose of this study was to investigate the usefulness of ultrasonography (US) for confirmation of endotracheal tube (ETT) placement during resuscitation in extremely low birthweight (ELBW) infants. Methods We conducted a retrospective review of the medical records of ELBW infants in whom ETT position was verified using US between June 2016 and September 2017. We investigated the backgrounds of the patients and US investigators, and the time required for the detection of exhaled carbon dioxide using the colorimetric method and US. Results Eleven ELBW infants were evaluated using US by four neonatologists. The median duration required to determine the ETT position by the colorimetric method and US were 11 s and 3 s, respectively. In six ELBW infants, we were able to verify the ETT position more rapidly using US than using the colorimetric method, and were able to perform prompt resuscitation. Unnecessary reintubations were avoided in three ELBW infants. Conclusion Ultrasonography allowed the swift confirmation of the tracheal intubations. The colorimetric method yielded false negative results; in such cases, unnecessary reintubation could have been avoided if US was used. We assessed the mechanism of false negative results and performed appropriate resuscitation.

BACKGROUND Appropriate management of the endotracheal tube (ETT) insertion depth is important. The depth calculated using Tochen's formula is overestimated in extremely-low- birthweight infants, particularly those with a birthweight