The Usefulness of Continuous Respiratory Sound Monitoring for the Detection of Pulmonary Atelectasis in a Ventilated Extremely Low Birth Weight Infant

TL;DR

A new system for continuous monitoring of respiratory sounds helped detect and treat lung collapse in a premature infant.

Contribution

A novel acoustic monitoring system for continuous, objective respiratory sound evaluation in neonatal care.

Findings

The system detected pulmonary atelectasis through attenuated breath sounds and hypoxemia progression.

Lung lavage treatment was confirmed effective by normalization of lung-sound spectrograms and improved clinical outcomes.

The system enabled noninvasive, bedside detection of acute lung abnormalities in a ventilated ELBWI.

Abstract

The assessment of auscultation using a stethoscope is unsuitable for continuous monitoring. Therefore, we developed a novel acoustic monitoring system that continuously, objectively, and visually evaluates respiratory sounds. In this report, we assess the usefulness of our revised system in a ventilated extremely low birth weight infant (ELBWI) for the diagnosis of pulmonary atelectasis and evaluation of treatment by lung lavage.

A female infant was born at 24 weeks of age with a birth weight of 636 g after emergency cesarean section. The patient received invasive mechanical ventilation immediately after birth in our neonatal (NICU). After obtaining informed consent, we monitored her respiratory status using the respiratory-sound monitoring system by attaching a sound collection sensor to the right anterior chest wall. On day 26, lung-sound spectrograms showed that the breath sounds were attenuated simultaneously as hypoxemia progressed. Finally, chest radiography confirmed the diagnosis as pulmonary atelectasis. To relieve atelectasis, surfactant lavage was performed, after which the lung-sound spectrograms returned to normal. Hypoxemia and chest radiographic findings improved significantly. On day 138, the patient was discharged from the NICU without complications. The continuous respiratory-sound monitoring system enabled the visual, quantitative, and noninvasive detection of acute regional lung abnormalities at the bedside. We, therefore, believe that this system can resolve several problems associated with neonatal respiratory management and save lives.

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