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Pleura-ABCDE – a structured expert-based protocol for neonatal lung ultrasound documentation and interpretation

Abstract

Background

Neonatal lung ultrasound is a rapidly emerging imaging modality with increasing impact, but lacks standardized protocols and curricula, resulting in inconsistent dissemination and quality assurance.

Methods

This retrospective cohort study was conducted at a Canadian tertiary-level neonatal intensive care unit (NICU) between January 2020 and December 2024.

Eligible participants included preterm infants born at < 29 weeks’ gestation who underwent both clinical echocardiography and LU within a 24-hour interval between days 7 and 14 of life, with echocardiographic documentation of PDA characteristics.

Infants were excluded if they had chromosomal abnormalities, major congenital malformations, or if only one of the two imaging modalities (echocardiography or LU) was performed during the study period. The study received approval from the institutional research ethics board, and all procedures were conducted in accordance with the principles outlined in the Declaration of Helsinki.

Results

We present a structured protocol for documentation and interpretation of lung ultrasound.

For each lung region, the acronym Pleura-ABCDE is used to analyze the pleura (sliding, morphology), A-Lines, B-Lines, Consolidation, Dynamics (lung point, double lung point) and Effusion. The structured documentation and interpretation could provide clues to differentiate respiratory diseases in newborns.

Conclusion

The Pleura-ABCDE protocol provides structured documentation and interpretation support for lung ultrasound in neonates. In contrast to flowchart-based protocols, a pattern-based approach and link to clinical presentation allows an integrative perspective on the use of neonatal lung ultrasound.

Therefore, with this expert-based proposal, we aim to improve documentation and thereby support diagnostic quality and reproducibility, as recommended by international ultrasound societies.

READ MORE HERE: https://theultrasoundjournal.springeropen.com/articles/10.1186/s13089-025-00442-4

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