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Deep Dive: An insightful research on Lung Ultrasonography by Dr. Liujing

November 10
02:10 2018

Professor Dr. Liujing is the Director of NICU and the Vice President of Bayi Children’s Hospital, affiliated with the Army General Hospital of the Chinese PLA. He has published over 280 papers, 10 books, and many chapters in books. The Natural Science Foundation supported his research work. He has won great acclaim and has won more than 10 awards for science and technology for the Chinese government.

Dr. Liujing’s recent study in the journal CHEST Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn, The Diagnosis of Neonatal Pulmonary Atelectasis Using Lung Ultrasonography and Lung Ultrasonography for the Diagnosis of Severe Neonatal pneumonia has some interesting and important findings.

Lung ultrasonography is a useful diagnostic technique, which is highly useful for the diagnosis of pneumonia in children and in adults.

Dr. Liujing with his team performed a study from September 2012 to October 2013 on 80 neonates. These neonates were admitted to Bayi Children’s Hospital, Beijing and were divided into two groups on the basis of their medical history, clinical manifestations, and chest radiography findings. Out of these, 40 neonates with severe pneumonia and 40 neonates with no lung disease were observed.

All neonates underwent bedside lung ultrasound examination in an undisturbed state. A comparison was made on the basis of pleural line abnormalities, B lines, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, and lung pulse.

Dr. Liujing and his team found that the results, which were associated with infectious pneumonia, included large areas of lung consolidation. These were found to have irregular margins and air bronchograms, pleural line abnormalities, and interstitial syndrome. It was also noticed that a large area of lung consolidation with irregular margins had 100% sensitivity and 100% specificity for the diagnosis of neonatal pneumonia.

Liujing concluded in his research that lung sonography was a reliable tool for diagnosing neonatal pneumonia. According to him, it was suitable for routine use in the neonatal ICU, which would have further potential to replace chest radiography and CT scanning.

A second study by Dr. Liujing was on the usefulness of lung ultrasonography for the diagnosis of Neonatal Pulmonary Atelectasis (NPA). The results of this study showed that 60 of the 80 with signs of NPA on lung ultrasound also had signs of NPA on chest radiograph (CXR) and the other 20 patients had signs of NPA on chest CT scan while there were no abnormal findings on CXR (termed occult lung atelectasis). It was concluded that lung ultrasonography was once again an accurate and reliable method for diagnosing NPA; most importantly it was able to detect occult lung atelectasis which not be diagnosed on CXR. Hence, Dr. Liujing and his team inferred that routine lung ultrasonography was a useful method of diagnosing or excluding NPA in neonates.

Another research by Dr. Liujing was conducted on the sensitivity and specificity of ultrasound for diagnosing transient tachypnea of the newborn (TTN). In this study, a total of 1358 infants were observed. Here, the group of researchers identified 412 cases without pulmonary diseases, 228 TTN cases, 358 respiratory distress syndrome (RDS) cases, 85 meconium aspiration syndrome (MAS) cases, 215 infectious pneumonia cases, and 60 other cases.

The study showed pulmonary edema as the primary ultrasonic characteristic of TTN. The most important findings of this paper were that the “double lung point” was neither a specific nor sensitive sign for the diagnosis of TTN using lung ultrasound because this sign only appeared at the acute stage of some parts of lungs in patients with mild TTN and the recovery stage of some patients with severe TTN. This was found to be very different from the previous studies.

Another interesting finding was that there were no specific ultrasonic signs for the diagnosis of TTN.

These findings will affect the future of diagnosing TTN as it was previously based on clinical history, typical clinical presentation, arterial blood gas analysis, and chest radiographic examination and despite the elaborate complex processes, it was often found that it led to about 70% or so misdiagnosis. However, in Liujing’s opinion, his study indicates that lung ultrasound can in all likelihood avoid this misdiagnosis and can emerge as a tough challenger to make an accurate and reliable diagnosis for TTN.

However, Dr. Liujing’s does mention that there were limitations of this study. He thus plans to carry forward his studies on how ultrasound can be made use of in the best possible way to diagnose TTN.

Dr. Liujing has proved that the spirit of a scientific quest in the medical field is infinite. His brilliant in-depth research work is a true role model for all future scientists.

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