Lung ultrasound is increasingly used in neonatal intensive care units. We summarized the ultrasonographic patterns, features of most neonatal respiratory morbidities, and clinical application in neonates. Lung ultrasound is a non-invasive, radiation-free, and reproducible adjunct tool that can guide the clinical management of neonates presenting with respiratory distress.
JardinFFarcotJ-CBoisanteL, et al.Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med1981; 304(7): 387–392. DOI: 10.1056/nejm198102123040703.
2.
DesaiSRHansellDM. Lung imaging in the adult respiratory distress syndrome: current practice and new insights. Intensive Care Med1997; 23: 7–15. DOI: 10.1007/s001340050284.
3.
WangJWeiHChenH, et al.Application of ultrasonography in neonatal lung disease: an updated review. Front Pediatr2022; 10: 1020437. DOI: 10.3389/fped.2022.1020437.
4.
AndersonKLFieldsJMPanebiancoNL, et al.Inter-rater reliability of quantifying pleural B-lines using multiple counting methods. J Ultrasound Med2013; 32(1): 115–120. DOI: 10.7863/jum.2013.32.1.115.
5.
StewartDLElsayedYFragaMV, et al.Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes. Pediatrics2022; 150(6): e2022060053. DOI: 10.1542/peds.2022-060052.
6.
RaimondiFYousefNMigliaroF, et al.Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res2021; 90(3): 524–531. DOI: 10.1038/s41390-018-0114-9.
7.
RuossJLBazacliuCCachoN, et al.Lung ultrasound in the neonatal intensive care unit: does it impact clinical care?Children2021; 8: 1098. DOI: 10.3390/children8121098.
8.
BratRYousefNKlifaR, et al.Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr2015; 169(8): e151797. DOI: 10.1001/jamapediatrics.2015.1797.
9.
SantosTMFranciDCoutinhoCMG, et al.A simplified ultrasound-based edema score to assess lung injury and clinical severity in septic patients. Am J Emerg Med2013; 31(12): 1656–1660. DOI: 10.1016/j.ajem.2013.08.053.
10.
ViaGStortiEGulatiG, et al.Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol2012; 78(11): 1282–1296.
11.
BrusaGSavoiaMVergineM, et al.Neonatal lung sonography: interobserver agreement between physician interpreters with varying levels of experience. J Ultrasound Med2015; 34(9): 1549–1554. DOI: 10.7863/ultra.15.14.08016.
12.
JainL. Respiratory morbidity in late-preterm infants: prevention is better than cure. Am J Perinatol2008; 25: 75–78. DOI: 10.1055/s-2007-1022471.
13.
KasapBDumanNÖzerE, et al.Transient tachypnea of the newborn: predictive factor for prolonged tachypnea. Pediatr Int2008; 50(1): 81–84. DOI: 10.1111/j.1442-200X.2007.02535.x.
14.
ZanardoVSimbiAKFranzoiM, et al.Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery. Acta Paediatr2004; 93(5): 643–647. DOI: 10.1080/08035250410026671.
15.
CopettiRCattarossiL. The ‘double lung point’: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology2007; 91(3): 203–209. DOI: 10.1159/000097454.
16.
SoldatiGDemiMDemiL. Ultrasound patterns of pulmonary edema. Ann Transl Med2019; 7(S1): S16. DOI: 10.21037/atm.2019.01.49.
17.
SoldatiGDemiM. The use of lung ultrasound images for the differential diagnosis of pulmonary and cardiac interstitial pathology. J Ultrasound2017; 20: 91–96. DOI: 10.1007/s40477-017-0244-7.
18.
VolpicelliGMelnikerLACardinaleL, et al.Lung ultrasound in diagnosing and monitoring pulmonary interstitial fluid. Radiol Med2013; 118(2): 196–205. DOI: 10.1007/s11547-012-0852-4.
19.
BiasucciDGLoiBCentorrinoR, et al.Ultrasound-assessed lung aeration correlates with respiratory system compliance in adults and neonates with acute hypoxemic restrictive respiratory failure: an observational prospective study. Respir Res2022; 23: 360. DOI: 10.1186/s12931-022-02294-1.
20.
MarteliusLSüvariLJanérC, et al.Lung ultrasound and static lung compliance during postnatal adaptation in healthy term infants. Neonatology2015; 108(4): 287–292. DOI: 10.1159/000438453.
21.
BlankDAKamlinCOFRogersonSR, et al.Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study. Arch Dis Child Fetal Neonatal Ed2018; 103(2): F157–F162. DOI: 10.1136/archdischild-2017-312818.
22.
HermansenCLLorahKN. “Respiratory distress in the newborn”, 2007. DOI: 10.5005/jp/books/12113_15.
23.
KurlSHeinonenKMKiekaraO. The first chest radiograph in neonates exhibiting respiratory distress at birth. Clin Pediatr1997; 36(5): 285–289. DOI: 10.1177/000992289703600506.
24.
CopettiRCattarossiLMacagnoF, et al.Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology2008; 94(1): 52–59. DOI: 10.1159/000113059.
25.
RaimondiFMigliaroFSodanoA, et al.Can neonatal lung ultrasound monitor fluid clearance and predict the need of respiratory support?Crit Care2012; 16(6): R220. DOI: 10.1186/cc11865.
PiastraMYousefNBratR, et al.Lung ultrasound findings in meconium aspiration syndrome. Early Hum Dev2014; 90: S41–S43. DOI: 10.1016/S0378-3782(14)50011-4.
28.
JovandaricMZMilenkovicSJDotlicJ, et al.Neonatal pneumothorax outcome in preterm and term newborns. Medicina2022; 58(7): 965. DOI: 10.3390/medicina58070965.
29.
RaimondiFRodriguez FanjulJAversaS, et al.Lung ultrasound for diagnosing pneumothorax in the critically ill neonate. J Pediatr2015; 175: 74–78. DOI: 10.1016/j.jpeds.2016.04.018.
30.
AlrajabSYoussefAMAkkusNI, et al.Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care2013; 17(5): R208. DOI: 10.1186/cc13016.
31.
SlovisTL. “Children, computed tomography radiation dose, and the as Low as Reasonably Achievable (ALARA) concept”. Pediatrics2003; 112: 971–972. DOI: 10.1542/peds.112.4.971.
32.
NewmanBCallahanMJ. ALARA (as low as reasonably achievable) CT 2011--executive summary. In: Pediatric radiology. Berlin, Germany: Springer, 2011. DOI: 10.1007/s00247-011-2154-8.
33.
ReidCLChandraratnaANKawanishiD, et al.Echocardiographic detection of pneumomediastinum and pneumopericardium: the air gap sign. J Am Coll Cardiol1983; 1(3): 916–921. DOI: 10.1016/S0735-1097(83)80209-5.
34.
AllgoodNLBrownleeJRGreenGA. Inability to view the heart through the subxiphoid echocardiographic window: a harbinger of disaster. Pediatr Cardiol1994; 15(1): 27–29. DOI: 10.1007/BF00797002.
35.
NgLSaulTLewissRE. Sonographic evidence of spontaneous pneumomediastinum. Am J Emerg Med2013; 31(2): e3–e4. DOI: 10.1016/j.ajem.2012.08.019.
36.
TestaACandelliMPignataroG, et al.Sonographic detection of spontaneous pneumomediastinum. J Ultrasound Med2008; 27(10): 1507–1509. DOI: 10.7863/jum.2008.27.10.1507.
37.
ZachariahSGharahbaghianLPereraP, et al.Spontaneous pneumomediastinum on bedside ultrasound: case report and review of the literature. West J Emerg Med2015; 16(2): 321–324. DOI: 10.5811/westjem.2015.1.24514.
38.
Van GelderenWFC. Ultrasound diagnosis of an atypical pneumomediastinum. Pediatr Radiol1992; 22(6): 469. DOI: 10.1007/BF02013517.
39.
JungAYYangIGoHS, et al.Imaging neonatal spontaneous pneumomediastinum using ultrasound. J Med Ultrason2014; 41(1): 45–49. DOI: 10.1007/s10396-013-0454-3.
40.
KüngEHabrinaLBergerA, et al.“Diagnosing pneumomediastinum in a neonate using a lung ultrasound”. Lancet2021; 398: e13. DOI: 10.1016/S0140-6736(21)01592-0.
41.
PeredaMAChavezMAHooper-MieleCC, et al.Lung ultrasound for the diagnosis of pneumonia in children. A Meta-Analysis2015; 135: 714–722. DOI: 10.1542/peds.2014-2833.
42.
BouhemadBDransart-RayéOMojoliF, et al.Lung ultrasound for diagnosis and monitoring of ventilator-associated pneumonia. Ann Transl Med2018; 6(20): 418. DOI: 10.21037/atm.2018.10.46.
43.
MongodiSViaGGirardM, et al.Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest2016; 149(4): 969–980. DOI: 10.1016/j.chest.2015.12.012.
44.
MongodiSDe VitaNSalveG, et al.The role of lung ultrasound monitoring in early detection of ventilator-associated pneumonia in COVID-19 patients: a retrospective observational study. J Clin Med2022; 11(11): 3001. DOI: 10.3390/jcm11113001.
45.
TsungJWKesslerDOShahVP. Prospective application of clinician-performed lung ultrasonography during the 2009 H1N1 influenza A pandemic: distinguishing viral from bacterial pneumonia. Crit Ultrasound J2012; 4(1): 16. DOI: 10.1186/2036-7902-4-16.
46.
CaiuloVAGarganiLCaiuloS, et al.Lung ultrasound in bronchiolitis: comparison with chest X-ray. Eur J Pediatr2011; 170(11): 1427–1433. DOI: 10.1007/s00431-011-1461-2.
47.
JiangPWeiJ. The application of pulmonary ultrasound in neonatal ventilator-associated pneumonia. Front Pediatr2022; 10: 882056. DOI: 10.3389/fped.2022.882056.
48.
BancalariEJainD. Bronchopulmonary dysplasia: 50 Years after the original description. Neonatology2019; 115(4): 384–391. DOI: 10.1159/000497422.
49.
JensenEAEdwardsEMGreenbergLT, et al.Severity of bronchopulmonary dysplasia among very preterm infants in the United States. Pediatrics2021; 148(1): e2020030007. DOI: 10.1542/peds.2020-030007.
50.
GilfillanMBhandariABhandariV. “Diagnosis and management of bronchopulmonary dysplasia”. BMJ2021; 375: n1974. DOI: 10.1136/bmj.n1974.
51.
HoshinoYAraiJMiuraR, et al.Lung ultrasound for predicting the respiratory outcome in patients with bronchopulmonary dysplasia. Am J Perinatol2022; 39(11): 1229–1235. DOI: 10.1055/s-0040-1721848.
52.
MohamedAMohsenNDiambombaY, et al.Lung ultrasound for prediction of bronchopulmonary dysplasia in extreme preterm neonates: a prospective diagnostic cohort study. J Pediatr2021; 238: 187–192.e2. DOI: 10.1016/j.jpeds.2021.06.079.
53.
RaimondiFMigliaroFCorsiniI, et al.Neonatal lung ultrasound and surfactant administration: a pragmatic, multicenter study. Chest2021; 160(6): 2178–2186. DOI: 10.1016/j.chest.2021.06.076.
54.
Alonso-OjembarrenaASerna-GuerediagaIAldecoa-BilbaoV, et al.The predictive value of lung ultrasound scores in developing bronchopulmonary dysplasia: a prospective multicenter diagnostic accuracy study. Chest2021; 160: 1006–1016. DOI: 10.1016/j.chest.2021.02.066.
55.
Alonso-OjembarrenaALechuga-SanchoAMMorales-ArandojoP, et al.Lung ultrasound score and diuretics in preterm infants born before 32 weeks: a pilot study. Pediatr Pulmonol2020; 55(12): 3312–3318. DOI: 10.1002/ppul.25098.
56.
LoiBVigoGBaraldiE, et al.Lung ultrasound to monitor extremely preterm infants and predict bronchopulmonary dysplasia a multicenter longitudinal cohort study. Am J Respir Crit Care Med2021; 203(11): 1398–1409. DOI: 10.1164/rccm.202008-3131OC.
57.
LiuJChenSWLiuF, et al.BPD, Not BPD, or iatrogenic BPD: findings of lung ultrasound examinations. Medicine (United States)2014; 93(23): e133. DOI: 10.1097/MD.0000000000000133.
58.
KasniyaGWeinbergerBCeriseJ, et al.Lung ultrasound assessment of pulmonary edema in neonates with chronic lung disease before and after diuretic therapy. Pediatr Pulmonol2022; 57(12): 3145–3150. DOI: 10.1002/ppul.26150.
59.
Sánchez-BecerraJCGuillén-TorresRBecerra-BecerraR, et al.Targeted neonatal echocardiography and lung ultrasound in preterm infants with chronic lung disease with and without pulmonary hypertension, screened using a standardized algorithm. Front Pediatr2023; 11: 1104940. DOI: 10.3389/fped.2023.1104940.
60.
Alonso-OjembarrenaAMorales-NavarroARodriguez-MedinaJ, et al.The increase in diaphragm thickness in preterm infants is related to birth weight: a pilot study. Eur J Pediatr2023; 182(8): 3723–3732. DOI: 10.1007/s00431-023-05052-7.
61.
MohsenNNasefNGhanemM, et al.Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: a prospective observational study. Pediatr Pulmonol2023; 58(2): 530–539. DOI: 10.1002/ppul.26223.
62.
RehanVKLaiprasertJWallachM, et al.Diaphragm dimensions of the healthy preterm infant. Pediatrics2001; 108(5): E91. DOI: 10.1542/peds.108.5.e91.
63.
Aldecoa-BilbaoVBalcells-EsponeraCHerranz BarberoA, et al.Lung ultrasound for early surfactant treatment: development and validation of a predictive model. Pediatr Pulmonol2021; 56(2): 433–441. DOI: 10.1002/ppul.25216.
64.
GuptaRBandyopadhyayTYadavB, et al.Sonographic assessment of diaphragmatic thickness and excursion to predict CPAP failure in neonates below 34 weeks of gestation: a prospective cohort study. Pediatr Pulmonol2023; 58: 2889–2898. DOI: 10.1002/ppul.26608.
65.
DaniCFuscoMMantiS, et al.Effects of caffeine on diaphragmatic activity in preterm infants. Pediatr Pulmonol2023; 58(7): 2104–2110. DOI: 10.1002/ppul.26439.
66.
NobileSSbordoneASalceN, et al.Diaphragm atrophy during invasive mechanical ventilation is related to extubation failure in preterm infants: an ultrasound study. Pediatr Pulmonol2024; 59(4): 855–862. DOI: 10.1002/ppul.26818.
67.
RadicioniMLeonardiALanciottiL, et al.How to improve CPAP failure prediction in preterm infants with RDS: a pilot study. Eur J Pediatr2021; 180(3): 709–716. DOI: 10.1007/s00431-020-03700-w.
68.
RadicioniMPennoniSFantauzziA, et al.Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration. J Ultrasound2023; 27: 87–96. DOI: 10.1007/s40477-023-00820-5.
69.
MaurizioRRinaldiVECameriniPG, et al.Right diaphragmatic peak motion velocities on pulsed wave tissue Doppler imaging in neonates: method, reproducibility, and reference values. J Ultrasound Med2019; 38(10): 2695–2701. DOI: 10.1002/jum.14974.
70.
SollRF. “Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome”. Cochrane Database Syst Rev2013; 11: CD001456. DOI: 10.1159/000353673.
71.
De MartinoLYousefNBen-AmmarR, et al.Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics2018; 142(3): e20180463. DOI: 10.1542/peds.2018-0463.
72.
SweetDGCarnielliVGreisenG, et al.European consensus guidelines on the management of respiratory distress syndrome - 2016 update. Neonatology2017; 111(2): 107–125. DOI: 10.1159/000448985.
73.
SweetDGCarnielliVGreisenG, et al.European consensus guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology2019; 115: 432–450. DOI: 10.1159/000499361.
74.
BadurdeenSKamlinCOFRogersonSR, et al.Lung ultrasound during newborn resuscitation predicts the need for surfactant therapy in very- and extremely preterm infants. Resuscitation2021; 162: 227–235. DOI: 10.1016/j.resuscitation.2021.01.025.
75.
PerriASbordoneAPattiML, et al.Early lung ultrasound score to predict noninvasive ventilation needing in neonates from 33 weeks of gestational age: a multicentric study. Pediatr Pulmonol2022; 57(9): 2227–2236. DOI: 10.1002/ppul.26031.
76.
BouhemadBBrissonHLe-GuenM, et al.Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med2011; 183(3): 341–347. DOI: 10.1164/rccm.201003-0369OC.
77.
SantuzPBonettiPSerraA, et al.Ultrasound-guided lung recruitment in a young infant with ARDS. Paediatr Anaesth2010; 20: 895–896. DOI: 10.1111/j.1460-9592.2010.03379.x.
78.
BahgatEEl-HalabyHAbdelrahmanA, et al.Sonographic evaluation of diaphragmatic thickness and excursion as a predictor for successful extubation in mechanically ventilated preterm infants. Eur J Pediatr2021; 180(3): 899–908. DOI: 10.1007/s00431-020-03805-2.
79.
TruongDAboSWhish-WilsonGA, et al.Methodological and clinimetric evaluation of inspiratory respiratory muscle ultrasound in the critical care setting: a systematic review and meta-analysis. Crit Care Med2023; 51(2): e24–e36. DOI: 10.1097/CCM.0000000000005739.
80.
PangPSRussellFMEhrmanR, et al.Lung ultrasound–guided emergency department management of acute heart failure (BLUSHED-AHF): a randomized controlled pilot trial. JACC Heart Fail2021; 9(9): 638–648. DOI: 10.1016/j.jchf.2021.05.008.
81.
Rodríguez-FanjulJLlopASBalaguerM, et al.Usefulness of lung ultrasound in neonatal congenital heart disease (LUSNEHDI): lung ultrasound to assess pulmonary overflow in neonatal congenital heart disease. Pediatr Cardiol2016; 37(8): 1482–1487. DOI: 10.1007/s00246-016-1461-0.
82.
Girona-AlarcónMCuaresma-GonzálezARodríguez-FanjulJ, et al.LUCAS (lung ultrasonography in cardiac surgery) score to monitor pulmonary edema after congenital cardiac surgery in children. J Matern Fetal Neonatal Med2022; 35(6): 1–6. DOI: 10.1080/14767058.2020.1743660.
83.
YuLFXuCKZhaoM, et al.Bedside cardiopulmonary ultrasonography evaluates lung water content in very low-weight preterm neonates with patent ductus arteriosus. World J Clin Cases2021; 9(8): 1827–1834. DOI: 10.12998/wjcc.v9.i8.1827.
84.
ZongHHuangZLinB, et al.The predictive value of lung ultrasound score on hemodynamically significant patent ductus arteriosus among neonates ≤25 weeks. Diagnostics2023; 13(13): 2263. DOI: 10.3390/diagnostics13132263.
85.
SavoiaMMcNamaraPJTitoloA, et al.Lung ultrasound score parallels trends in systemic haemodynamics after PDA ligation: a case series. Eur J Pediatr2022; 181(6): 2541–2546. DOI: 10.1007/s00431-022-04451-6.
86.
DassiosTArattu ThodikaFMSNanjundappaM, et al.Diaphragmatic ultrasound and patent ductus arteriosus in the newborn: a retrospective case series. Front Pediatr2023; 11: 1123939. DOI: 10.3389/fped.2023.1123939.
87.
van TassellBWArenaRAToldoS, et al.Enhanced interleukin-1 activity contributes to exercise intolerance in patients with systolic heart failure. PLoS One2012; 7(3): e33438. DOI: 10.1371/journal.pone.0033438.
88.
MacGowanGAMannDLKormosRL, et al.Circulating interleukin-6 in severe heart failure. Am J Cardiol1997; 79(8): 1128–1131. DOI: 10.1016/S0002-9149(96)00063-X.
89.
Torre-AmioneGKapadiaSBenedictC, et al.Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from the studies of left ventricular dysfunction (SOLVD). J Am Coll Cardiol1996; 27(5): 1201–1206. DOI: 10.1016/0735-1097(95)00589-7.
90.
ManciniDMHensonDLaMancaJ, et al.Respiratory muscle function and dyspnea in patients with chronic congestive heart failure. Circulation1992; 86(3): 909–918. DOI: 10.1161/01.CIR.86.3.909.
91.
HughesPDPolkeyMILou HarrisM, et al.Diaphragm strength in chronic heart failure. Am J Respir Crit Care Med1999; 160(2): 529–534. DOI: 10.1164/ajrccm.160.2.9810081.
92.
SethiANimbalkarAPatelD, et al.Point of care ultrasonography for position of tip of endotracheal tube in neonates. Indian Pediatr2014; 51(2): 119–121. DOI: 10.1007/s13312-014-0353-8.
93.
DenningtonDValiPFinerNN, et al.Ultrasound confirmation of endotracheal tube position in neonates. Neonatology2012; 102(3): 185–189. DOI: 10.1159/000338585.
94.
LinglePA. Sonographic verification of endotracheal tube position in neonates: a modified technique. J Clin Ultrasound1988; 16(8): 605–609. DOI: 10.1002/jcu.1870160816.
DescampsCSBeisselAVo VanP, et al.Role of ultrasonography in the assessment of correct endotracheal tube placement in neonates. Acta Paediatr2020; 109(5): 1057–1059. DOI: 10.1111/apa.15097.
97.
ShenJDuYSunY, et al.Modified lung ultrasound score for bronchopulmonary dysplasia predicts late respiratory outcomes in preterm infants. Pediatr Pulmonol2023; 58(9): 2551–2558. DOI: 10.1002/ppul.26546.
98.
Alonso-OjembarrenaALubián-LópezSP. Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants. Pediatr Pulmonol2019; 54(9): 1404–1409. DOI: 10.1002/ppul.24410.
99.
CorsiniILenziMBCiarciàM, et al.Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants. Eur J Pediatr2023; 182: 5375–5383. DOI: 10.1007/s00431-023-05200-z.
100.
Gomond-Le GoffCVivaldaLFolignoS, et al.Effect of different probes and expertise on the interpretation reliability of point-of-care lung ultrasound. Chest2020; 157(4): 924–931. DOI: 10.1016/j.chest.2019.11.013.
101.
LichtensteinDGoldsteinIMourgeonE, et al.Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology2004; 100(1): 9–15. DOI: 10.1097/00000542-200401000-00006.
102.
BrenneHFollestadTBergsengH, et al.Inter-rater reliability of the Silverman and Andersen index-a measure of respiratory distress in preterm infants. PLoS One2023; 18(6 June): e0286655. DOI: 10.1371/journal.pone.0286655.
103.
PatelABAminASorteySZ, et al.Impact of training on observer variation in chest radiographs of children with severe pneumonia. Indian Pediatr2007; 44(9): 675–681.
104.
SnepvangersYBurgerHDe WinterP, et al.Chest radiograph scores in preterm infants: interobserver agreement and relation to respiratory function. Biol Neonate2004; 86(2): 85–91. DOI: 10.1159/000077783.
105.
EscourrouGDe LucaD. Lung ultrasound decreased radiation exposure in preterm infants in a neonatal intensive care unit. Acta Paediatr2016; 105: e237–e239. DOI: 10.1111/apa.13369.