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Lung ultrasound and postoperative follow-up of congenital diaphragmatic hernia

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A CORRESPONDENCE to this article was published on 18 September 2023

Abstract

Lung ultrasound (LU) has emerged as a valuable tool for assessing pulmonary aeration noninvasively, rapidly, and reliably in different neonatal conditions. However, its role in the preoperative and postoperative evaluation in congenital diaphragmatic hernia (CDH) is still poorly analyzed. We present a cohort of 8 patients diagnosed with CDH who underwent lung ultrasound examinations at various time points before and after surgical correction. The lung ultrasound patterns were compared between two groups: mechanical ventilation ≤ 7 days (MV ≤ 7) and mechanical ventilation > 7 days (MV > 7). The ultrasound findings were also compared to CT scans and chest X-ray images to assess its diagnostic capacity for identifying postoperative complications: pneumothorax, pleural effusion, and pneumonia. Group MV ≤ 7 exhibited a normal pattern even at 48 h postsurgery, while group MV > 7 presented interstitial or alveolointerstitial pattern in both lungs for prolonged periods (2–3 weeks). Furthermore, contralateral LU pattern may be predictive of respiratory evolution.

  Conclusion: Lung ultrasound is a valuable tool for evaluating the progressive reaeration of the lung following surgical correction in CDH patients. It demonstrates the ability to diagnose common postoperative complications without the need for radiation exposure while offering the advantages of quick and serial assessments. These findings highlight the potential of lung ultrasound as an effective alternative to conventional imaging methods in the management of CDH.

What is Known:

• Lung ultrasound evaluates lung aeration and predicts respiratory outcomes in neonatal patients.

What is New:

• Lung ultrasound is useful in the postsurgical management of congenital diaphragmatic hernia patients, detecting reaeration and respiratory complications.

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Abbreviations

BW:

Birth weight

CDH:

Congenital diaphragmatic hernia

CT-scan:

Computed tomography scan

ECMO:

Extracorporeal membrane oxygenation

GA:

Gestational age

HFOV:

High-frequency oscillator ventilation

LU:

Lung ultrasound

MV:

Mechanical ventilation

nCPAP:

Nasal continuous positive airway pressure

NICU:

Neonatal intensive care unit

O/E LHR:

Observed/expected lung-to-head ratio

PH:

Pulmonary hypertension

SENeo:

Spanish Society of Neonatology

S/F index:

Peripheral saturation/inspired oxygen fraction index

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Acknowledgements

We would like to thank patients and their families. We are also in debt with NICU nurses and assistants who helped us performing the studies.

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Authors and Affiliations

  1. Neonatology Department, Gregorio Marañón Hospital, Madrid, Spain

    R. Gregorio-Hernández, C. Ramos-Navarro, S. Vigil-Vázquez, E. Rodríguez-Corrales, A. Pérez-Pérez, M. Arriaga-Redondo & M. Sánchez-Luna

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  1. R. Gregorio-Hernández
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  2. C. Ramos-Navarro
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  3. S. Vigil-Vázquez
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  7. M. Sánchez-Luna
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Contributions

Rebeca Gregorio-Hernández designed the study, performed the acquisition and analysis of the data and draft the text. Sara Vigil Vázquez, María Arriaga-Redondo, Alba Pérez-Pérez and Cristina Ramos-Navarro collected data during the study period. Elena Rodriguez-Corrales performed statistical analysis, Manuel Sánchez-Luna made contributions to the conception of the work and revised the work critically. All the authors revised and approved the final version of the text.

Corresponding author

Correspondence to R. Gregorio-Hernández.

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Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee (Gregorio Marañón Hospital, reference number 379/22) and the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all legal guardians of the patients included in the study.

Competing interests

The authors declare no competing interests.

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Communicated by Daniele De Luca

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Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary material 1: Lung ultrasound at diagnosis (case nº3) (MP4 1628 KB)

Supplementary material 2: Pneumothorax lung point in high frequency oscillatory ventilation (case nº5) (MP4 3367 KB)

Supplementary material 3: Right posterolateral consolidation with dynamic bronchogram (case nº6) (MP4 3345 KB)

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Gregorio-Hernández, R., Ramos-Navarro, C., Vigil-Vázquez, S. et al. Lung ultrasound and postoperative follow-up of congenital diaphragmatic hernia. Eur J Pediatr 182, 3973–3981 (2023). https://doi.org/10.1007/s00431-023-05074-1

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