The question every parent is asking when their premature baby is in respiratory distress is the same question I am asking as the neonatologist: what specifically is causing this breathing problem, and what does it need? A premature baby in respiratory distress is working hard to breathe, with rapid breathing, visible recession of the chest wall with each breath, and often a grunting sound that the baby makes in an attempt to keep the airways open. These signs tell me the baby's lungs are struggling, but they do not tell me why. The answer to why changes the treatment entirely. A premature infant born at 28 to 30 weeks of gestation has lungs that have not yet produced adequate surfactant, the substance that keeps the tiny air sacs from collapsing with every breath. This is respiratory distress syndrome (RDS), and it is treated with exogenous surfactant administered directly into the trachea through a fine tube. A baby with a pneumothorax, where air has escaped from the lung into the chest cavity and is compressing the remaining lung, needs immediate needle decompression of that air. A baby with pneumonia from an infection needs antibiotics. The clinical signs of all three can overlap in the first hours of life. Lung POCUS allows me to distinguish between these entities immediately, at the cot, without moving the baby. The specific ultrasound patterns associated with each diagnosis are distinct: RDS produces a characteristic pattern of dense B-lines replacing the normal air-filled lung appearance. Pneumothorax produces absence of the normal movement of the lung with breathing, combined with a specific finding called the lung point. Pneumonia produces consolidation, where the affected lung segment appears solid rather than aerated. At Vatsalya Children's Hospital, Varanasi, a lung POCUS in my hands at the cot side takes approximately two minutes and gives me the information I need to direct the treatment without delay.
Related reading:
Neonatal POCUS: How Bedside Ultrasound Helps Diagnose and Monitor the Sickest Newborns
POCUS in Paediatrics: How Bedside Ultrasound Is Changing the Way Children Are Diagnosed and Treated
Point of Care Ultrasonography (POCUS) in Pediatrics: Benefits for Faster Diagnosis and Better Outcomes
Newborn Care Guide: Managing Prematurity, Low Birth Weight, and Neonatal Infections Effectively
Written by Dr. Chhaya Pathak, MBBS, MD (Paediatrics), Senior Consultant Paediatrician, Neonatologist and Intensivist, Pioneer of Paediatric POCUS in Eastern Uttar Pradesh, Co-Founder, Vatsalya Children's Hospital, Varanasi 221002. Phone: +91 9838585111.
