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Open Access 01-01-2021 | Pleural Effusion | Original Article

Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

Authors: Nora Tusor, Angela De Cunto, Yousef Basma, John L. Klein, Virginie Meau-Petit

Published in: European Journal of Pediatrics | Issue 1/2021

Abstract

No consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.

Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology.

What is Known:

• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.

• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease.

What is New:

• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.

• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

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Title: Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound
Authors: Nora Tusor
Angela De Cunto
Yousef Basma
John L. Klein
Virginie Meau-Petit
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Pleural Effusion
Antibiotic
Pneumonia
Lung Ultrasound
Published in: European Journal of Pediatrics / Issue 1/2021
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-020-03710-8

At a glance: The STEP trials

Springer Medicine

Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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