Title: Ultrasound Diagnosis and Grading of Neonatal Respiratory Distress Syndrome
LUS Characteristics of RDS
The diagnosis of RDS by LUS is mainly based on the following characteristics and criteria:(1)Lung consolidation accompanied by airbronchograms:Lung consolidation is the most important LUS manifestation of RDS.The degree of consolidation is related to the disease severity, which is characterized by the following:①Early-stage and mild RDS can be characterized by the GOS.It is easier to find this kind of minor lesion when parallel-scanning during the examination.②Progress-stage or severe RDS is characterized by SFS.SFS-like lung consolidation is the most characteristic RDS ultrasound imaging performance.③Lung consolidation in infants with mild RDS is limited to the pleural, falls within a small range and is localized.Conversely,consolidation areas may extend to deeper and larger parts of the lung fields in more severe RDS and even lead to large areas of atelactasis.④Usually,the consolidation areas are bilaterally visible in different lung fields.Nevertheless, they may be limited to certain intercostal spaces on one side of the lung.(2)The pleural line is abnormal, and the A-lines disappear.The pleural line abnormality can manifest as the pleural line thickening, being interrupted, or disappearing.(3) Double lung point:There can be a double lung point during acute-stage mild RDS or the recovery stage of severe RDS.(4)Pleural effusion:Between 15% and 20% of patients may have different degrees of unilateral or bilateral pleural effusion. (5)The inconsistencies in the lesion degree and pathological properties of different parts of the lung: LUS studies have proved that the lesion degree and pathological properties may be different in different fields of the bilateral lung or even on the same side of the lung.
Ultrasound grading methods and criteria of RDS
①Grade Ⅰ RDS: Grade Ⅰ RDS is mild RDS or the early stage of RDS, in which the lung consolidation presents as GOS-like consolidation on ultrasound.②Grade Ⅱ RDS:Grade Ⅱ RDS is moderate RDS in which the lung consolidation presents as SFS-like consolidation on ultrasound but does not yet involve all of the lung fields.③Grade Ⅲ RDS:Those with any of the following criteria belong to this category:①The SFS-like lung consolidation has already affected 12 regions of the lungs on ultrasound;②The SFS-like lung consolidation does not involve all of the lung fields but has caused serious complications, such as pulmonary hemorrhage and/or pneumothorax and/or PPHN and/or a large area of atelectasis, etc.
Jing Liu is the Director of Department of Neonatology and NICU, Beijing Chaoyang District Maternal and Child Health Care Hospital. He is good at neonatal intensive critical care, neonatal brain ultrasound and lung ultrasound.Recent 10 years, he focused on neonatal lung ultrasound research, in his NICU, lung Ultrasound has completely replaced X-rays to diagnose neonatal lung disease for five years,avoiding bronchopulmonary dysplasia of premature infants. His academic positions include the Chairman of society of Pediatrics, Asia-Pacific Health Association;the Chairman of the Division of Critical Ultrasound, pediatric society of Asia-Pacific Health Association; the Associate Chairman World Interactive Network Focused On Critical Ultrasound China branch;the Associate Chairman of Chinese Neonatologist Association and the Editorial members of more than 30 Chinese and English Journals. Dr. Liujing has published more than 300 papers, over 12 books and Chapters in Books. He also received 15 science and technology awards at various levels.
Title: Hemoglobin levels and postoperative outcome in pediatric surgical patients
Background: Postoperative outcome in children is multifactorial. Among the reported predictors of postoperative outcome, preoperative anemia has been related to adverse outcome in children. A secondary analysis was undertaken to determine the correlation between hemoglobin levels and postoperative outcome in children included in a cohort of an observational pediatric study published previously since this analysis has not been done.
Objective: To determine the correlation between preoperative, intra-operative, postoperative hemoglobin levels and postoperative outcome in children in neurosurgery, abdominal and orthopedic surgery. Methods: Secondary analysis of a sub-cohort of 252 pediatric surgical patients with a median age of 62 months 12.50-144.00.
Results: Preoperative hemoglobin levels were negatively correlated to length of stay in the intensive care unit (LOSICU) (p=0.002), to length of hospital stay (LOS) (p<0.0001), to the number of patients with intra-operative and/or postoperative complications (p<0.0001) and to resurgery (p<0001). Low preoperative hemoglobin levels below 6 g/dL were correlated to higher postoperative LOSICU and LOS. Intra-operative hemoglobin levels were negatively correlated to LOS (p<0.0001) and to the number of patients with intra-operative and/or postoperative complications (p=0.004). Low intraoperative hemoglobin levels below 5 g/dL were correlated to higher LOS. Postoperative hemoglobin levels were positively correlated to LMV (p=0.002).
Conclusion: Hemoglobin levels are among other multifactorial predictors of postoperative outcome in pediatric surgical patients emphasizing the importance of a global patient blood management implementation program to improve outcome in surgical children.
Keywords: Anemia, hemoglobin levels, pediatric surgery, postoperative outcome, patient blood management, transfusion.
Claudine Kumba graduated as Medical Doctor in 2001, completed her specialization in Anesthesiology in 2006 at the Université Libre de Bruxelles, ULB, Brussels, Belgium. She has a Pediatric Anesthesia specialization graduation since 2010 from University of AixMarseille, France. She has a specialization graduation in Echocardiography applied to Anesthesia and Critical Care from University of Montpellier 1, 2011-2012, France. She has a Critical Care Medicine specialization graduation since 2014 from University of Montpellier 1, France. She is a Medical Doctor in Pediatric Anesthesia- Critical Care in Necker Enfants-Malades University Hospital, Assistance Publique Hôpitaux de Paris, Université de Paris, France