The Description of Lung Ultrasound from Initial Neonatal Transition in Extremely Preterm Infants

The Royal Women's Hospital and Monash University

The Description of Lung Ultrasound from Initial Neonatal Transition, The DOLFIN Jr Study. The DOLFIN Jr study is an innovative approach to improving our ability to predict which extremely preterm infants will require mechanical ventilation after birth and which infants will be able to manage with non-invasive ventilation.

Rates of mortality and morbidity are extremely high in our tiniest patients who are born prematurely. We know that over half of the infants born ≤28 weeks will receive mechanical ventilation as a life-saving therapy. We also know that mechanical ventilation causes damage to the fragile lungs of the developing premature infant and avoidance or reduction in length of mechanical ventilation would decrease the risk of chronic lung disease, developmental delay, and even death. However, prompt intubation and delivery of surfactant, if needed, is more preferable versus waiting until the premature infant has signs of severe respiratory distress syndrome. Therefore, a diagnostic tool that is easy to use and can accurately predict which infants are appropriate for non-invasive ventilation and which infants will need mechanical ventilation would be extremely valuable. In the extremely premature infant, time is critical, the ideal diagnostic tool is safe, simple, quick, and can be used immediately after birth.

We believe that lung ultrasound may offer neonatologists the ability to evaluate the need for mechanical ventilation in extremely premature infants. In 2017, we have published two studies using ultrasound to describe changes in the term and late preterm infant’s lungs as the newborn initiates breathing. We discovered that the pulmonary transition from fetal to ex-utero life in the healthy term baby occurs within 10 minutes of birth. Our investigation was the first report of lung ultrasound in the delivery room and the earliest use of lung ultrasound published. Other groups have reported that lung ultrasound at 1-2 hours after delivery can predict the need for mechanical ventilation, however, we believe that an earlier assessment would improve care and target therapies. The DOLFIN Jr study is an extension of our previous investigation to understand if lung ultrasound in the delivery room within 10 minutes of birth, also offers diagnostic value in extremely premature infants at high risk for respiratory distress syndrome and mechanical ventilation.

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