Bogdan Florin Gont, Loredana Mitran, Vlad Dima, and Simona Vlădăreanu

Abstract: Background: Hydrocephalus in preterm and term newborns is a condition with an important impact on medical care and the neurological development of patients, with high expenditures regarding daily care.

Imaging nowadays provides valuable information regarding the aetiology of the condition, and it represents a great aid in monitoring the development of the patients. Materials and methods: In this article, we present the cases of five patients with hydrocephalus, for which different imaging methods were used to detect and treat the underlying aetiology, emphasizing the cranial ultrasound examination.

Results: The results provided valuable information regarding the utility and feasibility of ultrasound. Moreover, Prechtl’s Assessment of General Movements is yet another useful tool, which in correlation with the use of cranial ultrasound can provide good insight regarding the evolution of the affected newborns.

The Kurjak Antenatal Neurodevelop- mental Test (KANET, KANE Test) comes in handy in the case of prenatal neurological assessments. Conclusions: Ultrasound examination proves to be a worthy tool capable of detecting the aetiology; however, in several cases, a complementary imaging examination might be needed. The therapeutic approach should take into consideration the diverse aetiology of the disease.

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Adrian Ioan Toma, Vlad Dima, Lidia Rusu, Alexandra Floriana Nemes, Bogdan Florin Gont, Alexandra Arghirescu, Andreea Necula, Alina Fieraru, Roxana Stoiciu, Larisa Andrăsoaie, Loredana Mitran, Claudia Mehedint, and Al Jashi Isam

Abstract: Background/Objectives: Our research aimed to assess if correlations could be

found between items evaluated at the cerebral ultrasound performed at term-equivalent

age (TEA) and neuro-motor outcomes evaluated at 12 and 24 months of corrected age in

a group of preterm infants. Methods: The following were assessed: the Levine Index,

the diagonals of the lateral ventricles, the size of the ventricular midbody, the sinocortical

distance, the width of the basal ganglia, the cortical depth at the level of the cingular sulcus

and the maturation of the gyral folding. The neurologic evaluation was performed at

12 and 24 months of corrected age, according to the Amiel Tison neurologic examination,

and the items from the calendar of motor acquisitions were used as outcome measures of

the study—gross and fine motor subsets. The comparisons between the different groups

were performed using the FANOVA test, with a statistically significant association for a

p < 0.05. Results: The abnormal gross motor acquisitions at 12 months were significantly

associated with an increased size of the ventricular midbody (p < 0.009) and a signifi-

cantly decreased diameter of the basal ganglia (p < 0.011) on the TEA cerebral ultrasound.

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Adrian Ioan Toma 1,2,*, Vlad Dima 3,* , Alina Fieraru 1, Alexandra Arghirescu 1, Larisa Nicoleta Andrăs, oaie 1, Răzvan Chirap 1, Anelise Alina Coandă 4, Teodora Bujdei 4, Andreea Nicoleta Marinescu 5 and Al Jashi Isam 2

Abstract: Aim: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. Materials and methods: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. 

Results: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001—delivery room; r = 4.0443, p < 0.001—one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). Conclusions: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support.

Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm2 in 2021 to 3.76 Gy × cm2 in 2023 (36% reduction).

As a proportion of 95%, congenital vertebral anomalies are clinically insignificant [1]. However, these conditions can reflect in compression of the spinal cord and are divided into anomalies of the vertebral shape and number. Among all congenital vertebral anomalies, the highest probability of producing neurologic disabilities corresponds to hemiverte- brae [2]. Hemivertebra is a common cause of congenital scoliosis and results from a lack of formation of one-half of the vertebral body, having an incidence of 3/10,000 live births [3]. In fact, they are so rare that a recent study [4] found only 324 cases in a time frame of 34 years (1984–2019). This condition can present either as solitary or as a syndrome compo- nent: i.e., the split notochord syndrome, which often implies vertebral defects, from a bifid vertebra to hemivertebrae, or fused vertebrae [5] or Alagille syndrome, which is character- ized by the liver, heart damage, along with vertebral segmentation defects. Furthermore, hemivertebrae can be a part of the clinical aspect of the Robinow syndrome, dominated by mesomelia or acromesomelia, radioulnar synostosis, brachy-dactylia, syndactyly, ec- trodactyly, and craniofacial defects (micrognathia, macrocephaly, depressed nasal bridge, and hypertelorism) [6]. Moreover, hemivertebrae can be found as a congenital skeletal disability within fetal alcohol spectrum disorder [7].

Other syndromes that could imply the presence of hemivertebra are Jarcho-Levin syndrome, OEIS, and VACTERL syndrome. The association with spina bifida is not uncommon [8]. Thus, a chromosomal analysis can be offered even if the incidence of karyotypic abnormalities is low amongst fetuses with isolated vertebral malformation, but there is an increased risk for spina bifida in siblings [9].

Depending on the site of the development defect, hemivertebrae are classified as ven- tral, lateral, or dorsal. The affected half of the vertebral body may be absent or hypoplastic, respectively, the same for the pedicle or the rib, at the thoracic level.

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Abstract: Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. 

Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum.

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Lung ultrasound is based on the analysis of ultrasound artifacts generated by the pleura and air within the lungs. In recent years, lung ultrasound has emerged as an important alternative for quick evaluation of the patient at the bedside. Several techniques and protocols for performing lung ultrasound have been described in the literature, with the most popular one being the Bedside Lung Ultrasound in Emergency

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Lung ultrasound (LUS) is a dynamic, convenient, repeatable, non-radioactive, and semi-conductive method that can be used to evaluate extravascular lung water (ELWI) (1). B-lines, which are an imaging manifestation on LUS, are closely related to the severity of ELWI (2, 3).

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Ultrasound gel has been associated with outbreaks of infection in various settings worldwide and risk of contamination of non-sterile ultrasound gel has been highlighted. Such outbreaks have typically included serious clinical infections. ...