pediatric bedside ultrasonography

The Cranial Neurosonogram is the preferred method for viewing the infant's brain. Ultrasound tools are portable and may be used at the NICU bedside. This corresponds to the concept of point-of-care testing. The difficulties associated with moving newborns to CT or MRI rooms are eliminated. Furthermore, ultrasound is less expensive than CT, has no radiation impact, and does not require sedation, which is required for MRI. Cranial sutures are still open in newborns, allowing us to glimpse within the brain using ultrasonography...

INTRODUCTION: Pediatric brain injury is a common cause of emergency department (ED) referral. Although severe traumatic brain damage is less frequent, it could be primarily managed by non-pediatric critical care physicians called in for advice. Clinical evaluation is important, but radiology is of particular value in the case of severe brain injury. Transcranial Doppler may help the physician through neuromonitoring. CASE REPORT: We report the case of a 3-year-old male child brought into the pediatric ED for a moderate head injury...

OBJECTIVES: To report our single-center use of transcranial Doppler (TCD) for noninvasive neuromonitoring in pediatric patients with acute liver failure (ALF). DESIGN: Retrospective cohort from January 2016 to June 2019. SETTING: PICU in Bicêtre Hospital, Assistance Publique- Hôpitaux de Paris (AP-HP), a national referral center for pediatric liver transplantation. PATIENTS: Pediatric patients with severe ALF (prothrombin time < 30% and Hepatic Encephalopathy score ≥ 3), on continuous venovenous high-flow hemofiltration...

PURPOSE: To determine the accuracy of bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse (ETD) diameter ratios to predict space-occupying lesions (SOLs) or elevated intracranial pressure (ICP) in pediatric head trauma. METHODS: Children who presented to the emergency department with head trauma and underwent cranial computed tomography (CT) were enrolled and examined by ocular ultrasonography (US), and the ONSD was measured at 3 mm posterior to the globe and ETD were measured...

Pneumonia is a prevalent disease with considerable morbidity and mortality among the pediatric population. Early diagnosis and swift commencement of the correct treatment are vital for a favorable clinical outcome. Along with history-taking and clinical examination, imaging modalities commonly used, lung ultrasound provides a bedside, less invasive, radiation-free alternative to diagnose pneumonia when compared with other images such as chest x-ray (CXR) and computed tomography (CT) scan. It is therefore of the utmost magnitude to inspect the evidence of its accuracy and reliability in the diagnosis of this condition...

Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED.In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes...

PURPOSE: Intra-abdominal injury is a major cause of morbidity in children. Computed tomography (CT) is the reference standard for the evaluation of hemodynamically stable abdominal trauma. CT has an increased risk of long-term radiation induced malignancies and a possible risk associated with the use of iodinated contrast media. Contrast-enhanced ultrasound (CEUS) might represent an alternative to CT in stable children with blunt abdominal trauma (BAT). Nonetheless, CEUS in pediatrics remains limited by the lack of strong evidence...

Craniosynostosis (CS) is associated with increased intracranial pressure (ICP) and this elevation is of vital importance in children. Bedside optic nerve sheath diameter (ONSD) on ocular ultrasonography has begun to be increasingly used in recently. A patient who was diagnosed with CS, standard anesthesia monitoring and anesthesia were performed. Before and after the surgery, ONSD measurement was performed to follow the changes in ICP. ONSD measurement can be used as an effective, non-invasive, repeated, and easy-to-apply method to monitor the changes in the ICP in pediatric patients with CS who are planned to undergo craniectomy...

AIM: To assess the diagnostic performance of a simplified lung point-of-care ultrasound (POCUS) to confirm the correct positioning of an endotracheal tube (ETT) in a pediatric intensive care unit (PICU) used to chest radiography (CXR), and to compare the time to obtain the ETT position between POCUS and CXR. METHODS: We conducted a single-center prospective study in critically ill children requiring urgent endotracheal intubation. Esophageal tube malposition was first avoided using auscultation and end-tidal CO2...

BACKGROUND: The dynamic nature of neonatal hypoxic-ischemic encephalopathy (HIE) after birth necessitates reliable biomarkers to identify infants with evolving brain injury. This prospective cohort aims to use serial Doppler ultrasonography (US) to measure cerebral blood flow velocity and resistance index (RI) to help detect the time and evolution of the clinical encephalopathy. METHODS: A total of 60 neonates were enrolled all ≥36 weeks' gestation with perinatal acidemia, defined as a blood gas pH ≤ 7...

Ultrasonography (US) plays a major diagnostic role in the pre- and post-transplant evaluation of recipient and donor. In most cases, US remains the only necessary imaging modality. After pediatric kidney transplantation, US can ensure immediate bedside diagnosis of vessel patency and possible postoperative non-vascular complications. Criteria for US diagnosis of kidney vessel thrombosis and stenosis in the transplant will be presented. Non-vascular complications after kidney transplantation include hydronephrosis, hematoma, lymphocele, and abscess...

PURPOSE: Respiratory failure (RF) is one of the most common reasons for hospitalization in pediatric intensive care units (PICU). We propose a radiography-based severity score for the assessment of children with RF and investigate the possible associations with severity indices and outcome. MATERIALS AND METHODS: Children with acute RF admitted in PICU were enrolled. Disease severity scores [Pediatric Risk of Mortality (PRISM) and Pediatric Logistic Organ Dysfunction (PELOD)], the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2) ratios, duration of ventilator support (DVS), length of PICU and hospital stay (LOS), and outcome were recorded...

Critically ill patients who are intubated undergo multiple chest X-rays (CXRs) to determine endotracheal tube position; however, other modalities can save time, medical expenses, and radiation exposure. In this article, we evaluated the validity and interrater reliability of ultrasound to confirm endotracheal tube (ETT) position in patients. A prospective study was performed on intubated patients with cuffed ETTs. The accuracy of ultrasound to confirm correct ETT placement in 92 patients was 97.8%. Sensitivity, positive predictive value, and agreement of 97...

Background: The use and perceived value of transcranial Doppler (TCD) scope in paediatric critical care medicine has not been extensively documented. Objective: To describe the use of TCD to assess non-traumatic brain injury in patients admitted to four paediatric intensive care units (PICUs) in France. Methods: We prospectively included all children (aged under 18) assessed with inpatient TCD between November 2014 and October 2015 at one of the four PICUs. The physicians completed a questionnaire within 4 h of performing TCD...

Brain injury remains a leading cause of morbidity and mortality in children. We evaluated the feasibility of using a pediatric swine model to develop contrast-enhanced ultrasound (CEUS)-based measures of brain perfusion for clinical application in various types of brain injury monitoring. Six-week-old, 10-kg swine (N = 10) were anesthetized, and an acoustic window was created in the right frontal cranium to provide visualization of an oblique coronal plane and bilateral thalami. Ultrasound contrast agent was administered via a femoral venous catheter as a weight-based (0...

This article discusses a case involving a pediatric patient who presented to a large urban children's hospital in the Northeastern United States with complaints of migratory monoarticular joint swelling. The patient had presented with a swollen and painful left knee but with no other associated symptoms. He was nontoxic appearing, afebrile, and had normal vital signs. On examination, he was noted to have a tender and swollen left knee that was not erythematous, bruised, or warm to the touch. There was a history of fevers over the summer after returning home from a camping trip in a park located in the northeastern United States...

OBJECTIVE: The aims of our prospective observational study were to evaluate the (1) reliability of clinical signs in the early detection of diaphragm palsy (DP); (2) reliability of ultrasonography using echo machine as a bedside tool for the diagnosis of DP; and (3) does early diaphragm plication result in the improved outcome? We also sought to determine the incidence and predominant risk factors for DP and diaphragm plication at our center. MATERIALS AND METHODS: This prospective observational study included patients with suspected DP from January 2015 to December 2018...

Pediatric forearm and wrist fractures are common; furthermore, some are displaced and require manipulation and reduction. The procedure is commonly performed without real-time image guidance and evaluated radiographically after reduction and casting, leading to multiple reduction attempts and malalignment. Although fluoroscopy can provide real-time assessment of fracture alignment during the procedure, it is not readily available in many emergency departments (EDs) and involves radiation exposure. Ultrasonography is an alternative real-time imaging modality that is inexpensive and readily available...

Wrist trauma is common in children, typically requiring radiography for diagnosis and treatment planning. However, many children do not have fractures and are unnecessarily exposed to radiation. Ultrasound performed at bedside could detect fractures prior to radiography. Modern tools including three-dimensional ultrasound (3DUS) and artificial intelligence (AI) have not yet been applied to this task. Our purpose was to assess (1) feasibility, reliability, and accuracy of 3DUS for detection of pediatric wrist fractures, and (2) accuracy of automated fracture detection via AI from 3DUS sweeps...

Our aim was to summarise the current evidence and methods used to assess respiratory muscle function in the newborn, focusing on current and future potential clinical applications. The respiratory muscles undertake the work of breathing and consist mainly of the diaphragm, which in the newborn is prone to dysfunction due to lower muscle mass, flattened shape and decreased content of fatigue-resistant muscle fibres. Premature infants are prone to diaphragmatic dysfunction due to limited reserves and limited capacity to generate force and avoid fatigue...