Lung Ultrasound in Neonatology with Dr Nadya Yousef

00:00:04: Welcome to Neonatology Now, the official podcast of The European School Of Neonotology.

00:00:11: Here at Neonautology Now we are shining a light on real-world experiences of world renowned experts in perinatal medicine.

00:00:20: Together We will learn from top medical doctors researchers and opinion leaders To better understand how we can improve professional neonatal care In Europe And beyond.

00:00:32: It's not just about the science, it is about stories and experiences shaping this critical field of medicine.

00:00:40: And now without further ado let me introduce you to

00:00:44: your

00:00:45: host a seasoned neonatologist and our guide through these fascinating conversations Professor Mario Rudiger.

00:00:53: Mario take it away!

00:00:55: Welcome to new episode of Neonatology Now with podcast at European School of Neoneutology where we explore the most pressing topics in Neonatology.

00:01:05: Today's topic, neonatal lung ultrasound!

00:01:08: I'm Professor Riediger and my guest for today is professor Nadja Yusuf from Paris.

00:01:14: Neonautology know it a podcast were we explore cutting-edge developments of neonatal medicine.

00:01:19: A sign for specialists and young doctors passionate about advancing care on the NICU.

00:01:24: So this episode dedicated to tool that has fundamentally reshaped bedside diagnostics lung ultrasonic neonates.

00:01:32: So it's a real pleasure to welcome today's guest, Dr.

00:01:35: Nadja Yusuf.

00:01:36: Nadjia, Welcome to Neonatalgy now!

00:01:38: Thank

00:01:39: you very much Marju.

00:01:40: thank you for having me.

00:01:41: I'm really excited.

00:01:43: Yeah Dr.

00:01:43: Yusef is the leading neonatologist based in Paris and an internationally recognized expert in neonatal lung ultrasound And she has contributed to some of the most influential studies and guidelines on the field including the development of lung ultrason scoring systems for predicting surfactant need and international focus guidelines for critical ill neonates.

00:02:05: So her work has helped to establish lung ultrasound as a reliable radiation-free bedside tool, for diagnosing and managing neonatal respiratory disease such as arduous, transient tachypnoea and pneumothorax And with strong academic impact.

00:02:24: So there are thousands of citations in the central role and collaborative international research.

00:02:30: And Dr.

00:02:31: Youssef has also been instrumental in shaping how we train next generation in an address.

00:02:37: so that yeah, it was a very short introduction from my side.

00:02:41: What have I forgotten?

00:02:42: That is still important to you.

00:02:54: what I define myself, first and foremost as being a clinician.

00:02:59: And it's team player.

00:03:00: so i really think we were talking about lung ultrasound that is real value.

00:03:04: Is That It makes us better clinicians at the bedside regardless of What our role isn't caring for?

00:03:11: The newborn if Really easy tool that helps Us become Better decision-makers and better carers for patients.

00:03:19: Okay, so to learn more about my guests I always ask for a special anecdote in your professional career.

00:03:26: So i like this question again!

00:03:27: And so...I'm very curious.

00:03:29: what is YOUR anecdote?

00:03:32: Well..i have several really but they all go back to the fact that actually we're all working together as team.

00:03:39: it's just global perspective and how TOGETHER at least when you are talking long ultrasound takes everyone.

00:03:49: this tool become a tool that has its place in uniquely intensive care.

00:03:54: One thing I remember with much pride really is when Professor Daniel Lichtenstein, who is considered to be the father of critical-care ultrasound and of lung ultrasound came to visit our unit in Paris-Séclé.

00:04:07: we were trying out settings on an new machine.

00:04:11: while looking at pictures he asked one of the juniors what picture and the junior was young.

00:04:19: And then our, the nurse comes as says oh but Nanja look at this picture!

00:04:27: Don't you agree that it has so many B lines?

00:04:30: It's not well-ariated...and I was thinking..this is what its all about.

00:04:34: Its really working together with a team taking care of these patients and doesn't matter who your part of the team.

00:04:40: we have hearts to play.

00:04:43: My heart was bursting here in front.

00:04:49: And another thing I would see, just like to say a couple of things about all the works that we've been holding because We have been very honoured to have children come as volunteers up through the years and it has always been an important point.

00:05:05: That will be learning experience but not enjoyable or interesting.

00:05:10: It has paid off since they came back year after year And it goes from seeing children who, for example have been diagnosed with severe ADHD.

00:05:20: Who are just the perfect models to take ownership of a thing?

00:05:24: or the kids would take over the workshops and start explaining because they've understood?

00:05:28: Or just in fact way that defined themselves on.

00:05:31: this is actually very personal story.

00:05:33: my kids have been volunteers many years.

00:05:37: My second kid at school wrote a small piece on having been, this was the Paris EAPS conference.

00:05:45: And she wrote that piece of being in child volunteer and how kids seem from their perspective.

00:05:51: they give them time to actually help position care for children.

00:05:57: so they are contributing actively to improving pediatric and natal health care.

00:06:03: And it's true, I think they're not just here on the right there actually doing a major job.

00:06:08: so It takes all of us To make this very

00:06:11: interesting perspective from the child's position because say we are needed Just to train and so yeah that's interesting.

00:06:18: Yeah i had it really changed The way i looked at the dog from That point on Because he made perfect sense.

00:06:24: This was A conscious decision On their part to be a player in that room.

00:06:30: So when I started neonatology in the early nineties, so we just started to introduce ultrasonography and the NICU.

00:06:37: So bedside ultrasonic on the head sometimes echocardiography was very fancy stuff but nobody was thinking about doing ultra sonography of the lung.

00:06:49: But nowadays lung ultrasound has moved from a niche technique to a central bed side tool in Neonatology.

00:06:56: Can you walk us through the key milestones in development?

00:07:01: And actually what drove these adaptations, Nikius.

00:07:06: Yeah like when I started there was...I didn't know about any unique long ultrasound.

00:07:12: so i trained Norway and this is where my first ultrasound program learning how to do hip ultrasound.

00:07:19: at that time most neonatologists do some kind of point-of-care ultrasound, melee brain cardiac focus and so forth.

00:07:28: And it was for me really I guess the being at the right place at the time with the right people because iIwas working in a mixed PICU NIC unit to add to Kremlin Beset Hospital.

00:07:47: and one one day said, as he often did.

00:07:55: Guys were such losers who liked ears behind the adult medicine.

00:08:00: they've been doing lung ultrasound for so long and I said yeah i mean...I'm sure we can get better!

00:08:05: We are like ears behind that long ultrasound.

00:08:08: this was somewhere around two thousand nine uh.

00:08:11: ...and the two really for me my stone papers that have been published by Capetian Caterosi had just come out first describing TTN and then RDS using a trans-trastic approach.

00:08:26: And it was just an eye opener for me because I'd never even thought about

00:08:30: that,

00:08:31: actually together also by of course getting help from the anesthetists who were using it for acute care medicine training with Dani Lichtenstein... It really started to become interesting in the newborn population.

00:08:49: First by just seeing if we could see the same signs, trying to reproduce kind of what was on the first studies and then trying to see what we found in different pathologies like for example maconimus patients and malformations congenital hernias um.

00:09:05: and at some point being able to discuss with other likes professor Katarossi who again helped me see that it wasn't just black-and-white.

00:09:12: there's really more respect from them.

00:09:17: time goes on and somewhere around, I guess in the year of two thousand twelve.

00:09:21: Francesco Riemondi talks about pattern recognition and how we can actually predict the need for respiratory support and EQ admission just looking at that patterns in a transitional phase?

00:09:32: And then came to question what's it about if you gave your number?

00:09:35: because adults have been using lung ultrasound aeration score for some time mainly diseases like ARDS and ventilator associate pneumonia.

00:09:45: so could basically try and adopt score to the newborn, give a number that relates with the pattern.

00:09:55: And see whether or not it correlates with the oxygenation indexes because we were at the time still giving surfactant based on FI-II index... ...and possibly predicts how they need for the first dose of surfactants.

00:10:11: So this was work started by Daniela DeLuca.

00:10:16: we found out that actually even simple scoring systems.

00:10:20: In preterm infants with respiratory distress, give us information much earlier than these applied to thresholds and the story just took up from there.

00:10:31: I think that's longer.

00:10:33: sound has seen so much growth in the past years because there is a perceived added value.

00:10:45: That's probably why.

00:10:47: So I remember, I've invited Luigi Cattarossi in two thousand ten to the two instances and pose him to talk about.

00:10:53: everybody was responding saying oh you should have more clinical relevant topics not fancy research.

00:10:59: so nobody was very much excited about it.

00:11:04: but even talking about using adults already for lung ultrasound.

00:11:10: what is actually?

00:11:11: Well, the applications

00:11:18: are the same But I mean of course for acute care medicine if we do not talk about chronic lung diseases and interstitial disease in these kind of things.

00:11:29: when it comes to the acute Situations like pneumothorax effusion pneumonia Consolidation's either is the same.

00:11:38: but what makes this tools specifically?

00:11:40: Are you even exceptionally well adapted to them?

00:11:43: newborns that long is so superficial.

00:11:46: It is a superficial organ, but it is so superficial in the newborn and you see.

00:11:50: So well there's not much between the probe on the lung

00:11:55: And

00:11:57: of course its well adapted to the way we care for infants.

00:12:01: You can do skin-to-skin.

00:12:03: We don't need to disturb baby.

00:12:05: In itself indications and acute care could be same.

00:12:09: But now I've learned that even further.

00:12:12: For example diagnosing TTN, RDS, Meconium Aspiration, titrating and ventilation.

00:12:20: This is the only tool we have today because although chest x-rays are not extremely useful they do not give us same information.

00:12:28: so I would say it's just an extension.

00:12:30: It is what adults can take even further in this period of life.

00:12:36: So your work also helped to frame lung ultrasound as a diagnostic and functional tools on both sides.

00:12:44: How has this role changed our baby approach in the innate respiratory distress?

00:12:51: I feel that being able to make a diagnosis is important.

00:12:57: But, actually be able to have it tool and guide our management... ...is something that's a game changer.

00:13:05: Actually i even wonder if you might redefine some of the unique respiratory categories Because until now we've never really had adapted tools and it is the same with most of what were doing in unatology, isn't?

00:13:19: We have no adaptive tools.

00:13:21: Were extrapolating from adult to pediatric data or using material that's not adaptable for our patients... And actually we deserve better!

00:13:29: Our patients deserve better but so do we.

00:13:32: So a long-awaited sound although It has very simple technique does Very quickly give you an idea about the underlong aeration.

00:13:43: It's like putting on glasses.

00:13:45: when you really have fuzzy sights, You can see stuff which makes your understand what is going on.

00:13:50: and because we're good at the physiology part We know the underlying pathophysiology of different diseases by seeing these patterns that make sense to us And that really guides our management.

00:14:02: So instead I'm going forward blindly for actually basing out decisions About.

00:14:06: information were now getting.

00:14:07: That wouldn't be able get otherwise.

00:14:10: So we are trained to use X-ray nowadays, or maybe used to be trained with using x-rays which is more static.

00:14:19: Do you think the lung ultrasound still underused?

00:14:22: The functional or dynamic capacity of lung ultrasound is still underuse now a days?

00:14:28: I definitely think so!

00:14:30: We're just at the beginning.

00:14:32: one has actually been able to see how it can be used but on another fan there's.

00:14:37: having enough trained people make this a safe technique I think for many indications, it is highly superior to the diagnostic x-ray or chest X-rays.

00:14:48: That has been proven also through adult studies with CT scanners and so on.

00:14:53: but i also think that things take time And we should go forward safely.

00:14:58: You shouldn't just abandon one technique from another unless really you're trained in doing this.

00:15:02: But In future ,I believe able be a tool that is just perceived as the extension of our clinical examination and will use chest x-rays only if there's doubts about diagnosis or without seeing something.

00:15:16: So I think from a cost effectiveness point of view also, it here to stay.

00:15:24: But so initially a lung artisan was like more descriptive way?

00:15:31: And you have changed very much in scoring system because it's very important to have more objective approach.

00:15:41: But usually a scoring system depends on fixed regions and thresholds, so what is your opinion?

00:15:48: What are the main limitations of these approaches or why this may be important for rethink them?

00:15:54: I think that we always need to re-think our techniques.

00:15:57: just see if you can do better.

00:15:59: The first scoring system was published by Neonates.

00:16:02: the Bradscore was based upon, is based on three areas per lung.

00:16:07: A very simplified score and it was used in the beginning to see if we could predict a need for surfactant and to guide self-administration and now we have sufficient evidence.

00:16:18: actually We started and it worked, then we found out for other applications.

00:16:31: It was really promising for protection of BPD or managing different things.

00:16:37: but is this the best thing that you could do?

00:16:40: I mean...it works!

00:16:42: But maybe..we need to look at other areas.

00:16:44: Maybe we need too for certain indication extend the area as well As we have recommendations on what kind scoring systems should be used according to patient age.

00:16:54: Again, this is the beginning.

00:16:55: Make there some areas that are more predictive than others and just as another thing is a score's number but if you give us core without knowing what the underlying situation is it doesn't really have lots of does make sense.

00:17:10: If you haven't maybe with me to be your macaroni myspiration or preterm infant with um.

00:17:15: so we already asked they may Have the same score But then management would not be the same.

00:17:19: So you need two?

00:17:20: It is at end scan that you do the score.

00:17:24: It's not only the score or diagnosis, they have to come together.

00:17:29: So how much variability exists between operators?

00:17:32: We were talking about a position where you do this investigation but what about operator?

00:17:38: The studies show we're actually quite well correlated when you go through and test even with variable degrees of experience.

00:17:52: you're touching on a very important point, and I think if we read the studies when it comes to scoring for somebody who's learning to score just based upon papers there is still room for confusion.

00:18:05: The way that has been described like so although within each study operators doing this same study have good degree of reliability think that there is work to do, be sure we harmonize the way we're scoring and make it more easily accessible for anybody who would like to learn this technique.

00:18:27: Okay so one could very fancy stuff I think but sometimes its easier or focus on simplicity.

00:18:37: So I remember when we, in the early nineties there were different tests to predict surfactant deficiency and they're very highly sophisticated but didn't enter the clinics.

00:18:47: And so i think it's similar simplicity is sometimes more important than precision.

00:18:53: What are your opinions on the long ultrasound?

00:18:56: Oh...I believe that long ultrasounds should be as a simple technique.

00:19:04: It isn't easy but it's simple.

00:19:06: And because it is so simple, we need to do it correctly and it's paralyzing the fact that it always interprets in a clinical context using lung scores in addition as very valuable.

00:19:18: But again I agree with you Do not overcomplicate things.

00:19:21: It just pictures on a grayscale screen but its value lies what gives us information In underlying processes of lungs.

00:19:30: That's a

00:19:33: good point, because recently some groups or you have published data showing that fewer lung regions may be sufficient to predict the effect of need.

00:19:43: And so I was thinking about what does it explain us?

00:19:47: About the pathophysiology... So is it very homogenous surfactant deficiency on later stages and not too homogeneous?

00:19:57: It's very interesting isn't?

00:20:00: And I think that once you start using Langondreson, do you start to question a lot of what we've always learned specifically?

00:20:07: I would say in the transitional phase.

00:20:10: I am looking forward to seeing where this takes like for example Virginie Mopiti's work Using Machine Learning and AI To try identify which areas will be more predictive than others.

00:20:22: because exactly What does it really mean?

00:20:25: they showed everything.

00:20:26: each region should be weighted the same if we were to go from the principle that, for example, affecting deficiencies of a genus

00:20:35: disease.

00:20:35: But again where only thing things on the surface when looking at lung ultrasound is only reflection or what's going out in the surface?

00:20:43: What do you know?

00:20:43: For example it comes too long airway and lung clearance.

00:20:48: It's very heterogeneous.

00:20:51: We don't know enough about this.

00:20:53: So really opens up of interesting perspectives, doesn't it?

00:20:57: I'm very excited to learn

00:20:59: more.

00:21:00: So you think it will help us also for let's say better understanding chronic lung disease because BPD is a topic i am very much interested in and It's very difficult.

00:21:12: so nobody knows what BPD really like.

00:21:15: And do we have the chance to use lung ultrasonography To understand the development of BPD?

00:21:23: I think at least partially.

00:21:26: you know, when we started looking at searly scanning the babies and.

00:21:31: When we saw there was a difference to weigh the lungs I will use term cleared up after RDS or surfactant they don't really clear up.

00:21:38: it's just that the erasure gets better over time.

00:21:41: but then what is really a different than the patterns between the baby?

00:21:45: she took on their trajectory and got the BPD diagnosis thirty six weeks versus those who didn't?

00:21:51: so i think At least for the first time ever, we were able to get an insight like life bedside information on at least a surface changes of BPD.

00:22:02: And I think where would be extremely interesting?

00:22:06: Would it now with all these well... The few therapeutics that you have in the pipeline from BPD?

00:22:12: maybe once in UNL food care We could have clear answer to clinical questions You know Maybe if you were to recruit the infants in, uh...in this study if we're talking about efficacy.

00:22:27: In the beginning for babies who are at risk of BPD and then or maybe you know at least pre-select on criteria that have been proven to predict BPD would be able to ask it a question whether they will have some therapeutical advantage to these new techniques.

00:22:46: but other than that yes the fact is simple way.

00:22:53: And follow is a game changer, of course we know nothing about BPD after discharge.

00:22:59: there's not that many studies up to then and it's continuous process.

00:23:03: but I believe yes this part could be very valuable probably the only tool definitely accessible so interesting to explore.

00:23:17: So you were already talking about artificial intelligence, machine learning and introducing entering the field.

00:23:25: How do we see AI reshaping long ultrasound decision-making in your methodology?

00:23:33: Well there I see it as a broad spectrum.

00:23:35: really one is that the simple thing Long ultrasound is about pattern recognition and AI's probably much better than we are at recognizing patterns.

00:23:47: So I think that either when it comes to the machines we're using, they will sooner or later be equipped with AI algorithms to help us detect.

00:23:57: Or maybe help us on our decision making?

00:24:01: Maybe even to train us how you put the problem and so on.

00:24:04: but i also think from a more study research perspective um... We've been using just simple statistics for many- simple only just you know statistics without, and sometimes the fact that AI is so good at seeing patterns help us see things completely different.

00:24:23: And I think when we have this big data not unrelated to the images themselves but maybe two outcomes may be too so on...I think it will be very interesting!

00:24:32: In the end i think my real hope is because somehow am asking myself are you really looking after the new born lung?

00:24:40: The way we should?

00:24:44: Maybe through AI, we'll be able to see these patterns and start saying maybe you should look at this differently.

00:24:50: I don't know...I'm quite optimistic!

00:24:53: I think it will take us much further than without AI.

00:24:57: So i am also very interested in AI And then having a very optimistic look on this.

00:25:02: But there are always three different topics which I like to discuss about AI.

00:25:08: so that's the potential risk.

00:25:10: One is over reliance on the results.

00:25:14: The second one, it's black box decision so we don't understand what he is doing.

00:25:18: and finally loss of clinical intuition in tuition.

00:25:24: So What do you think?

00:25:26: Oh My responses I guess yes to all three But that is with everything.

00:25:34: Whenever will decide to take easy way out stop thinking ourselves.

00:25:38: It becomes tricky especially with something as simple, and as long as it sounds.

00:25:46: One thing I have a main concern about is the ongoing work on making the software in machines give us scores... ...and maybe even interpreting images for us.

00:26:07: It's that at least I believe, for the newborn.

00:26:11: We have not gone sufficiently back to the basics since we're only seeing reflections and artifacts of the lung And were using linear probes...I'm just wondering is everything we are seeing a real reflection?

00:26:26: Of what's going on or should be?

00:26:28: maybe take it before we rely completely On this benchmark at some point.

00:26:36: But yes, I agree.

00:26:38: Having a tool where you just do the scan and the machine tells your this-and-this is very good tool especially if in stressful situations or not having resources to have information on yourself as somebody more experienced Or maybe mentor or clinical resource but on the other hand over lines of anything If don't use brain Yeah.

00:27:07: I mean, long-awaited sound is basically the extension of your clinical examination.

00:27:11: You know you're patient and why are doing this scan?

00:27:15: But do you know underlying physiopathology?

00:27:19: No AI or not.

00:27:21: an AI tool can give you that answer.

00:27:23: It has to go through a clinical reason.

00:27:25: So i agree with it.

00:27:28: It's repotential but used.

00:27:31: What was the my guess?

00:27:33: Just one information more like a CRP, like a blood gas or an x-ray.

00:27:37: Exactly!

00:27:39: You have to make that clinical picture and find the clinical decision on

00:27:43: it... Yeah you're making sense of what we are seeing.

00:27:46: And if doesn't makes sense then why does not make sense right

00:27:52: now?

00:27:53: So Nathya you've been involved in recent international consensus work so I already mentioned What are the most important changes clinicians should know about regarding training and competency?

00:28:07: I think that, well i would say more than change is more then anything.

00:28:14: We're taking many people now holding courses or learning in unique lung ultrasound but we need to do this together.

00:28:32: let's say, rules so that we're safe.

00:28:37: We are safe for us as providers but also safe to the babies.

00:28:41: and although they aren't very specific in these recommendations there is some questions that have come up like how many scans do you need?

00:28:49: So we always limited by the fact of having little new data.

00:28:54: a lot is extrapolated not common sense.

00:28:56: But what I really like about one of these recommendations is in countries that have low or maybe not many resources, rural areas the fact we're learning now.

00:29:08: there are different ways to train.

00:29:12: There's no one size fits all for adult learners but we need to think about credentialing and competency.

00:29:20: We can do this in different ways.

00:29:26: There is training programs that are quite flexible, like hybrid models or other.

00:29:29: That could work but I think the message is yes.

00:29:33: we need to work together to deliver safe consistent training and make our practice safe because of course any clinicians who take care for sick newborn deserve it.

00:29:52: This is really something that it's tricky right now.

00:29:54: Also, another area has not been talked about in these guidelines or recommendations is mentoring but this is a difficult point.

00:30:05: how do we actually mentor somebody if you don't have the resources?

00:30:10: Because learning this technique probably isn't very difficult.

00:30:14: Recognize the patterns and anybody can.

00:30:18: The real challenge is with everything.

00:30:20: Once you are at the bedside, You can see stuff on the screen but what does it really mean for that thing?

00:30:25: This I think.

00:30:26: where we need to come together as a community.

00:30:28: this i think Is Where We Need To Be Concentrating Also And Creating A Network Of Mentors Collaborators So That Were Able To Help On Another Move Forward.

00:30:40: In Your Opinion What does an optimal training pathway look like today for a young neonatologist who wants to start this long ultrasound?

00:30:50: I think you should start at the beginning.

00:30:55: But always see it as part of your clinical examination, or part of global evaluation of patients.

00:31:03: The optimal training pathway is actually integrated in the way we do the stethoscope and how we started learning EKG on stethoscopes on training, bedside with a more experienced person at your side.

00:31:18: Learning how to be very systematic learning out not-to-take the easy way and being kind of humble because although it's simple technique It takes some time before you get this high experience when you bring finally understands what your hand is showing in the screen.

00:31:36: So that goes through knowing how to learn, how to do correct scans being very vigilant and the quality of your scams on saving them for review.

00:31:47: On actually being systematic in documenting everything uh... And sharing them together.

00:31:53: and then it's practice practice.

00:31:55: Of course.

00:31:57: so what you think?

00:31:57: How many scans does it take to become almost competent?

00:32:04: well That's a good question.

00:32:05: I think Nobody really knows, because it all depends whether or not you've been doing some kind of ultrasound before or not.

00:32:12: And we all have our different learning groups.

00:32:13: by probably somewhere around twenty-five to fifty scans You're fairly confident.

00:32:18: Some things are easier to learn than others Like for example if your question is can I recognize TTN?

00:32:24: Or RDS?

00:32:25: That's fairly quick If this rule out pneumothorax.

00:32:30: that Is fairly quick To make a diagnosis of pneumothorex.

00:32:35: And when you come into more complex things, where it's talked about the functional use.

00:32:39: When are using to make a decision at bedside?

00:32:42: Then you need have both clinical and ultrasound experience if your confident enough.

00:32:48: So I really feel that should be done.

00:32:49: as part of its team

00:32:51: You should combine your clinical experiences with pictures you're seeing.

00:32:57: It is important.

00:32:59: If I take the example of our unit where we have first year trainees who come in, they have a short theoretical introduction and then their trained bait side.

00:33:10: We do lots of points-of-care ultrasound lot's of lung ultrasounds.

00:33:13: so They're doing this with somebody on the bedside checking the quality saving the scans and so one.

00:33:20: And there will be an unit for six months.

00:33:22: Then learn how to do the scan independent scanners.

00:33:26: But we will not make this decision for these clinical decisions, because clinically there are still young trainees.

00:33:33: that would be done with the fallout.

00:33:36: For example whether or not to administer their treatment and how to guide ventilation?

00:33:42: So from your experience what is most common pit for clinicians when they start using nanotrisant?

00:33:48: We've made many mistakes.

00:33:50: I'll share some of them!

00:33:53: The first one isn't being systematic not just following, is it the lung?

00:34:00: Is this my lung surface.

00:34:01: Is there a long sliding?

00:34:02: what do I see?

00:34:04: because we had when we started learning how to use lung ultrasound scores and developing this technique with some kids were very nice course problem was We hadn't assessed for lungs lighting.

00:34:16: This child had pneumothoraxes.

00:34:18: This is dangerous right you really need to be.

00:34:21: another example could be that Because we're using the simple scores.

00:34:25: The first twenty four forty eight hours, you have an older patient may be an intubated patients and long after sound is.

00:34:32: you know this physics?

00:34:34: air goes up it goes down.

00:34:37: so if You have a child on the ventilator for example who?

00:34:41: Starts to need more respiratory support or oxygen?

00:34:45: you would look for reasons why.

00:34:48: And If your just scan was scan the anterior lateral parts and they look good.

00:34:54: And then you move around from there, say oh the score was low but you haven't looked where you're expecting pathology right?

00:35:00: So I would say that pitfalls are not being systematic... The pitfalls is again taking the easy way alright!

00:35:07: Not looking all like at the long also the posterior areas.. I'm not talking about the crashing infant situation because you will miss information Not taking the time, another pitfall is when we're training people are very interested in seeing pathology.

00:35:26: We all or...we both are because it's interesting.

00:35:29: but The more I scan babies the more i see the variability in normal scans In their transitional period.

00:35:36: so Recognizing the normal new naked lung Is something?

00:35:41: We need to train on also.

00:35:44: But I think the main thing is keeping It simple being systematic and keeping it simple.

00:35:48: if you do that then You're on a good way, especially when you enter the clinical picture because that is a third pitfall.

00:35:56: When you look at the picture and don't look at it or the clinical presentation then...

00:36:06: Okay so I'm always impressed how convincing you are, and so I'm sure our listeners will go.

00:36:17: start to do Lang-Retro Sonography now after listening the podcast.

00:36:22: So can you give three practical tips for a young doctor who wants to start Lang Retro Sound?

00:36:29: Number one – Start!

00:36:32: Don't wait for The Perfect Machine or The Perfect Probe.

00:36:36: Start.

00:36:37: number two just check your settings because most of our machines now are very cool and they have nice presets.

00:36:48: It can make it difficult to see for example long sliding, so take the time to recognize patterns on your machine with your probe And be patient Be kind Be humble Enjoy the ride.

00:37:06: What other resources or training would you recommend?

00:37:10: There are a number of, you mean for somebody wanting to start.

00:37:12: I think we're in an era where were starting.

00:37:15: get more and more courses.

00:37:17: And many countries already are delivering either short courses or workshops related to conferences like your symposium Mario.

00:37:29: I'm an ESMIC member so focus the ESMEC Focus Working Group holds courses And I'm also the president of The Friends Society of Pediatric and Unitarian Alumni, so we also hold courses.

00:37:42: Also in English but i think In the future will be seeing more hybrid courses.

00:37:47: So if you're interested as many sites will now announce courses either just long or partner-long and so on uh...in multiple countries above all being part I'll go back to this being part of the community.

00:38:08: This is how we work forward together, okay?

00:38:11: And there are also a chance for more experienced users To start to exchange pictures or so if they don't understand these like a research group Or experience user group you have

00:38:25: Yeah There are i know in many countries Have these kinds of collaboratives but i will point out what which started Vilnius with my colleague, Svetlana who has started the International Ultrasound Club.

00:38:40: Where every month there is a session where it start up with lung and now we're moving towards other applications of point-of-care ultrasound And now there are groups from France, Scandinavia Kazakhstan Iraq Egypt... Quite, you know it's exchanging and we're doing trying to do this in the New York also more for French speaking Colleagues because there is really a shortage in front-speaking resources or other languages.

00:39:15: But I think it's there.

00:39:16: I think moving forwards with that.

00:39:19: So people provide a link as show notes through these meetings.

00:39:23: right excellent.

00:39:24: So now they are you all so doing research?

00:39:27: What?

00:39:27: what does one research question that you would love to answer next?

00:39:33: There are so many.

00:39:35: But wouldn't you agree that we want to learn more about what's going on in the transitional phase, like the early transitional phase?

00:39:42: Yes right because I mean...I've scammed a lot of babies in their face whether without signs of respiratory distress and you see this but really changed.

00:39:53: my view was when i was in Mosul or Iraq two years ago doing training program.

00:40:00: The clinical context was different.

00:40:02: These were babies born through elective C-section, possibly a little bit before term and seeing the clinical picture and see the ultrasound findings it.

00:40:11: I had never seen anything like this.

00:40:14: all of the different patterns All the difference signs which is not what i have seen Before And we started to try and guess Which baby would need an EQ admission?

00:40:24: It's two hours.

00:40:25: We could keep the babies or not.

00:40:26: but in the end many Of these babies resolved their symptoms without anything, because I was thinking oh poor babies they don't have CPAP.

00:40:34: They just had maybe a little bit of oxygen and then they dwell.

00:40:37: so then i started to say well may be we're not... Maybe you were actually not helping the Mabies by putting them on CPAP as early as we do?

00:40:46: I'm not talking about preterm infancies where we are termed

00:40:48: babies um

00:40:50: and it-and I've started saying but really here..I really need to understand what's going on!

00:40:54: And with seeing this in many different settings More pathological changes are sometimes just babies needing more time.

00:41:04: So I think that would be extremely interesting to learn more about Just the beginning of life.

00:41:09: what happens?

00:41:10: It's very good here because in The resuscitation guidelines we have changed now not too and to start seep up Very early, but you know no good advice to recommend which baby will need CPAP or not benefit from CPAP and so maybe it's really a good idea.

00:41:34: I've been thinking about how i can convince you at the other co-authors that may be set this before in ABCDE, maybe E should for echo like ultrasound because what kind of evidence do for pneumothorax, for hernia, hyperbolemia.

00:41:52: What other quick and very good diagnostic tool do you have?

00:41:56: So I'm working on that.

00:42:00: You provide data and i will put it in the description.

00:42:03: so excellent!

00:42:05: It's a

00:42:08: deal yeah... At the end of our conversation just one final question for our young listeners what advice we have for young doctors regarding the balance between research?

00:42:19: That's a very good question.

00:42:21: I have found out that they go hand-in-hand when you're talking about clinical research, and i've done some lab research myself but it wasn't clinical questions...I started doing research on congenital cholesterol.

00:42:36: What do I feel is?

00:42:39: When are as lucky to be able to do clinical research?

00:42:44: It is a question of being curious and having the possibility of going further when you have clinical questions.

00:42:51: I think how are able to divide your time really depends more, i guess about resources in units?

00:43:00: The possibilities for supervision or clinical work.

00:43:06: here in France it's not always easy because of staffing issues.

00:43:13: Yeah,

00:43:16: so but if you're curious and If you have a question It's always interesting to continue.

00:43:23: ask why?

00:43:24: And all is the question what if What if And see often.

00:43:29: The most interesting studies are really simple to put forward.

00:43:34: I'm not talking about important randomized controlled trials.

00:43:37: i'm Talking About Studies Where You Have because when you're in the clinical situation, you have a clinical need or question.

00:43:45: And actually being true to yourself and going but further with the questions go into somebody who may help answer that question could be very interesting.

00:43:54: okay

00:43:56: thank you for sharing your insights in for incredible contribution field.

00:44:01: so I think

00:44:02: not only

00:44:03: am convinced by our listeners will we convince like ultrasound is no longer future But it's already transforming how we practice neonatology today.

00:44:13: So thank you very, very much!

00:44:16: That was again Neonatology Now the podcast of The European School Of Neonautology.

00:44:22: Mario Rödinger on the mic and my guest for Today Was Natja Jussef.

00:44:26: If you do have any questions or comments Do not hesitate to contact us.

00:44:30: Thank You For Listening.