Objective To evaluate the role of lung ultrasound in the diagnosis of neonatal pneumonia.Methods From April to October 2015, 100 neonates admitted to the Neonatal Department of Xi′an Children′s Hospital underwent lung ultrasound, using the 12 regions method. All intercostal spaces of the upper and lower parts of the anterior, lateral, and posterior regions of the left and right lung were examined. Arterial blood gas analysis parameters of each case were recorded at the same time, including arterial partial pressure of oxygen (PO2), arterial partial pressure of carbon dioxide (PCO2), pH value and oxygen saturation (SO2). A skilled sonographer analyzed the ultrasound images before being aware of the patient′s clinical condition. According to the ifndings, the patients were classiifed into 2 groups: neonatal pneumonia group and non-pneumonia group. All the patients with neonatal pneumonia underwent lung ultrasound score (LUS), and the correlation between LUS and PO2, PCO2, pH value and SO2 was analyzed.Results A ifnal diagnosis of neonatal pneumonia was conifrmed in 62/100 patients. The ultrasonographic manifestations of neonatal pneumonia were as follows: rocket sign (33/62 patients, 53%), ground-glass sign (35/62 patients, 56%) , waterfall sign (31/62 patients, 50%), white lung (8/62 patients, 13%), subpleural lung consolidation (35/62 patients, 56%), pleural line abnormalities (26/62 patients, 41%), pleural effusion (7/62 patients, 11%), atelectasis (3/62 patients, 4%) , and pneumothorax (1/62 patients, 1%). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of lung ultrasound in the diagnosis of neonatal pneumonia was 96.77%, 86.84%, 93.00% of 92.30%, of 94.28%, respectively. The correlation coefficients between LUS and PO2, PCO2, pH value, SO2 were-0.82, 0.64,-0.58,-0.74,P<0.05, respectively.ConclusionLung ultrasound is a reliable tool for diagnosing neonatal pneumonia with high sensitivity, with high practical value in assisting clinicians to carry out appropriate treatment in combination with LUS.%目的 探讨肺部超声对新生儿肺炎的临床诊断价值.方法 对2015年4~10月西安市儿童医院新生儿科连续收治的100例患儿进行肺部超声扫查,分别对双侧肺脏的前上、前下、侧上、侧下、后上、后下6个区域,共12个肺区进行纵向及横向扫查,记录检查当日动脉血气分析结果.由经验丰富的同一名超声医师,在不知晓临床诊断结果前对患儿超声图像进行分析,将超声诊断结果与临床诊断结果进行对照,总结肺炎组与无肺炎组患儿超声图像特征;肺炎组患儿进行超声肺评分(LUS),将LUS与动脉血气分析的氧分压(PO2)、二氧化碳分压(PCO2)、pH值、血氧饱和度(SO2)进行相关性分析.结果 肺炎组患儿肺部超声声像图特征:(1)超声"彗星尾"征(ULCs):"火箭"征33例(53%),"磨玻璃"征35例(56%),"瀑布"征31例(50%),弥漫性白肺8例(13%);(2)胸膜下肺实变35例(56%);(3)胸膜线异常26例(41%);(4)胸腔积液7例(11%);(5)肺不张3例(4%);(6)气胸1例(1%).肺部超声诊断新生儿肺炎的的特异度为86.84%,敏感度为96.77%,准确性为93.00%,阳性预测值为92.30%,阴性预测值为94.28%.LUS与PO2、PCO2、pH值、SO2相关(r=-0.82、0.64、-0.58、-0.74,P值均<0.05).结论 肺部超声检查的敏感度较高,可作为临床诊断新生儿肺炎的又一影像学方法,结合LUS,对指导临床治疗新生儿肺炎有一定的应用价值.
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