Deep learning approaches for automated classification of neonatal lung ultrasound with assessment of human-to-AI interrater agreement.

Neonatal respiratory disorders pose significant challenges in clinical settings, often requiring rapid and accurate diagnostic solutions for effective management. Lung ultrasound (LUS) has emerged as a promising tool to evaluate respiratory conditions in neonates. This evaluation is mainly based on the interpretation of visual patterns (horizontal artifacts, vertical artifacts, and consolidations).

Lung function response to postnatal corticosteroids for the prevention and treatment of bronchopulmonary dysplasia.

Background: Steroid treatment is well-known for producing clinically significant improvements in respiratory support requirements. In this study, we utilized lung ultrasound and respiratory oscillometry to objectively assess this response and determine if the combination of these methods can serve as a valuable tool for comparing different treatment strategies.

Methods: We conducted a retrospective observational study including preterm infants with a gestational age below 32 weeks and/or a birth weight below 1500 g.

Early respiratory system reactance predicts respiratory outcomes in preterm infants: a retrospective, multicentre study.

Objective: This multicenter, international, retrospective study aims to investigate whether respiratory system reactance (Xrs) assessed by respiratory oscillometry on the 7th day of life is associated with respiratory outcomes in preterm infants below 32 weeks' gestation.

Methods: Sinusoidal pressure oscillations (2-5 cmHO peak-to-peak, 10 Hz) were superimposed on the positive end-expiratory pressure (PEEP). We assessed the association of Xrs z-score with the duration of respiratory support using linear regression and with bronchopulmonary dysplasia (BPD, according to Jensen .

A Novel CPAP Device With an Integrated Oxygen Concentrator for Low Resource Countries: In Vitro Validation and Usability Test in Field.

To develop and validatea novel neonatal non-invasive respiratory support device prototype designed to operate in low-resource settings. The device integrates a blower-based ventilator and a portable oxygen concentrator. A novel control algorithm was designed to achieve the desired fraction of inspired oxygen (FiO) while minimizing power consumption.

Relationship between oscillatory volume and oscillatory pressure in neonatal high-frequency oscillatory ventilators: an in vitro study.

Objective: We analysed the relationship between oscillatory volume (V) and pressure amplitude (ΔP) in six neonatal high-frequency oscillatory (HFO) ventilators and related it to (1) the accuracy of V and ΔP measurements and (2) the maximal delivered ΔP.

Design: In vitro study.

Setting: Neonatal intensive care unit.

Effect of different lung recruitment strategies and airway device on oscillatory mechanics in children under general anaesthesia.

Background: Atelectasis has been reported in 68 to 100% of children undergoing general anaesthesia, a phenomenon that persists into the recovery period. Children receiving recruitment manoeuvres have less atelectasis and fewer episodes of oxygen desaturation during emergence. The optimal type of recruitment manoeuvre is unclear and may be influenced by the airway device chosen.

Hemodynamic evaluation in preterm infants using ultrasonic cardiac output monitor (USCOM).

We aimed to establish reference ranges for USCOM parameters in preterm infants, determine factors that affect cardiac output, and evaluate the measurement repeatability. This retro-prospective study was performed at Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy. We included infants below 32 weeks of gestational age (GA) and/or 1500 g of birth weight (BW).

Combining lung ultrasound and oscillatory mechanics for assessing lung disease in very preterm infants.

Background: We investigated whether combining lung ultrasound scores (LUSs) and respiratory system reactance (Xrs) measured by respiratory oscillometry explains the severity of lung disease better than individual parameters alone.

Methods: We performed a prospective observational study in very preterm infants. Forced oscillations (10 Hz) were applied using a neonatal mechanical ventilator (Fabian HFOi, Vyaire).

Oscillatory mechanics trajectory in very preterm infants: a cohort study.

Background: The aim of this study was to describe the trajectory of oscillatory mechanics from the first week of life to term equivalent and evaluate whether oscillatory mechanics are associated with simultaneous lung disease in infants ≤32 weeks gestation.

Methods: In this observational, longitudinal study, we enrolled 66 infants. Forced oscillations were applied using a neonatal mechanical ventilator (Fabian HFOi) that superimposed oscillations (10 Hz, amplitude 2.

State of the art on neonatal noninvasive respiratory support: How physiological and technological principles explain the clinical outcomes.

Noninvasive respiratory support has gained significant popularity in neonatal units because of its potential to reduce lung injury associated with invasive mechanical ventilation. To minimize lung injury, clinicians aim to apply for noninvasive respiratory support as early as possible. However, the physiological background and the technology behind such support modes are not always clear, and many open questions remain regarding the indications of use and clinical outcomes.

Association of intrauterine growth restriction and low birth weight with acute kidney injury in preterm neonates.

Background: Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants.

Ventilatory response and stability of oxygen saturation during a hypoxic challenge in very preterm infants.

Background: Preterm infants have immature control of breathing and impaired pulmonary gas exchange. We hypothesized that infants with bronchopulmonary dysplasia (BPD) have a blunted ventilatory response and peripheral oxygen saturation (SpO ) instability during a hypoxic challenge.

Methods: We evaluated the response to hypoxia in 57 very preterm infants (38 no BPD, 10 mild BPD, 9 moderate-to-severe BPD) at 36 weeks' postmenstrual age.

Bubble CPAP respiratory support devices for infants in low-resource settings.

Approximately 46% of the 5.2 million annual under-5 deaths derive from neonatal conditions commonly associated with hypoxemia or acute respiratory distress. It has been estimated that 98% of these deaths occur in low- and middle-income countries (LMICs).

Oscillatory mechanics in very preterm infants on continuous positive airway pressure support: Reference values.

Objective: To create reference values for respiratory system resistance (Rrs) and reactance (Xrs) measured by the forced oscillation technique (FOT) in nonintubated very preterm infants.

Design: Retrospective analysis of data collected as part of prospective observational studies in two centers.

Setting: Tertiary neonatal intensive care units.

Oscillatory Mechanics Response to Inhaled Bronchodilators in Very Preterm Infants: A Retrospective Study.

Objectives: To identify short-term repeatability of forced oscillation technique (FOT) measurement of lung function, assess the lung function response to bronchodilators (BDs) by FOT, and prove the concept that only some very preterm infants manifest a change in lung mechanics in response to BD.

Study Design: We retrospectively analyzed respiratory system resistance and respiratory system reactance measured by FOT (Fabian HFOi). The measurement short-term repeatability was assessed in 43 patients on 60 occasions; BD responsiveness was assessed using a different data set, including 38 measurements in 18 infants.

Left ventricular diastolic function and respiratory outcomes in preterm infants: a retrospective study.

Background: The role of left ventricular (LV) diastolic pressure in the pathophysiology of bronchopulmonary dysplasia (BPD) is unclear. We evaluated the trajectory of echocardiographic parameters of LV diastolic function and the association with respiratory outcomes in preterm infants.

Methods: We retrospectively analysed measurements of LV diastolic function (E, e', A, Ee' and E/A ratios) in infants below 32 weeks' gestation (GA).

An Experimental Apparatus for E-Nose Breath Analysis in Respiratory Failure Patients.

Background: Non-invasive, bedside diagnostic tools are extremely important for tailo ring the management of respiratory failure patients. The use of electronic noses (ENs) for exhaled breath analysis has the potential to provide useful information for phenotyping different respiratory disorders and improving diagnosis, but their application in respiratory failure patients remains a challenge. We developed a novel measurement apparatus for analysing exhaled breath in such patients.

Contactless Monitoring of Breathing Pattern and Thoracoabdominal Asynchronies in Preterm Infants Using Depth Cameras: A Feasibility Study.

Objective: Monitoring infants' breathing activity is crucial in research and clinical applications but remains a challenge. This study aims to develop a contactless method to monitor breathing patterns and thoracoabdominal asynchronies in infants inside the incubator, using depth cameras.

Methods: We proposed an algorithm to extract the 3D displacements of the ribcage and abdomen from the analysis of depth images.

Assessment of bronchodilator response by forced oscillation technique in a preterm infant with evolving bronchopulmonary dysplasia: A case report.

Inhaled bronchodilators are often given in preterm infants with evolving or established bronchopulmonary dysplasia. However, it is unclear which patients may benefit from it and when it is the best time to start treatment. The forced oscillation technique (FOT) is a noninvasive method for assessing lung mechanics that proved sensitive to airway obstruction reversibility in children and adults.

Volumetric Capnography at 36 Weeks Postmenstrual Age and Bronchopulmonary Dysplasia in Very Preterm Infants.

Objectives: To assess the feasibility of volumetric capnography in spontaneously breathing very preterm infants at 36 weeks postmenstrual age (PMA) and its association with clinical markers of lung disease including the duration of respiratory support and bronchopulmonary dysplasia (BPD).

Study Design: We obtained mainstream volumetric capnography measurements in 143 very preterm infants at 36 weeks PMA. BPD was categorized into no, mild, moderate, and severe according to the 2001 National Heart, Lung and Blood Institute workshop report.

Role of ventilator and nasal interface in pressure transmission during neonatal intermittent positive pressure ventilation: A bench study.

We aimed at evaluating pressure transmission and stability during non-synchronized neonatal nasal intermittent positive pressure ventilation (NIPPV) delivered using five mechanical ventilators and three nasal interfaces. An artificial nose-throat model was connected to a mechanical analog of the infant respiratory system and a breath generator. Ventilation was administrated via a nasal mask (NM), short bi-nasal prongs (SBN), or RAM® cannula.

Tidal Breathing Measurements in Former Preterm Infants: A Retrospective Longitudinal Study.

Objectives: To investigate, in infants born preterm with or without bronchopulmonary dysplasia (BPD), the trajectory of tidal breathing flow-volume (TBFV) parameters in the first 2 years of life; the association between TBFV parameters and perinatal risk factors; and the predictive value of TBFV parameters for rehospitalizations due to respiratory infections and wheeze.

Study Design: We retrospectively analyzed TBFV measurements performed at 0-6, 6-12, and 12-24 months of corrected age in 97 infants <32 weeks of gestation and <1500 g. We assessed the association between TBFV parameters and perinatal risk-factors using linear regressions and the predictive capacity for subsequent respiratory morbidity using logistic regressions.

Effect of nocturnal EPAP titration to abolish tidal expiratory flow limitation in COPD patients with chronic hypercapnia: a randomized, cross-over pilot study.

Background: Tidal expiratory flow limitation (EFL) promotes intrinsic PEEP (PEEPi) in patients with chronic obstructive pulmonary disease (COPD). Applying non-invasive ventilation (NIV) with an expiratory positive airway pressure (EPAP) matching PEEPi improves gas exchange, reduces work of breathing and ineffective efforts. We aimed to evaluate the effects of a novel NIV mode that continuously adjusts EPAP to the minimum level that abolishes EFL.