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Almudena AO, Alfonso Maria LS, Estefania RG, Blanca GM, et al. Pleural Line Thickness Reference Values for Preterm and Term Newborns. Pediatr Pulmonol. 2020 Jun 23. doi: 10.1002/ppul.24920.

Background: In lung ultrasound (LUS), the pleural line is an artifact whose thickness depends on the underlying lung pathology. To date there are no published studies on normal values of pleural line thickness (PLT) in newborns.

Objective: The aim of our study is to describe normal PLT values in term (TN) and preterm newborns (PTN).

Methods: We recruited eupneic TN and PTN, under 34 weeks of gestation, on their first 24 hours of life. Newborns presenting any respiratory distress since birth were excluded. LUS was performed in four areas: upper anterior, lower anterior, lateral and posterior. At each location, we measured PLT and values where compared. Intra- and inter-observer agreement were assessed using the intraclass correlation coefficient (ICC), and the kappa coefficient.

Results: We included 23 TN with a median birth weight of 3365g (Interquartile rank (IQR) 3100-3575g) and a median gestational age of 39 weeks (IQR 38-40 w). In the PTN group, 23 patients were included with a median birth weight of 1350g (IQR 1150-1590 g) and a median gestational age of 31 weeks (IQR 30-32w). Median PLT values were less than 1 mm, and there were no significant differences between groups at any locations, with the exception of the left lower anterior field (0.79 mm (IQR 0.72-0.89 mm) versus 0.68 mm (IQR 0.62-0.72mm). Intra-observer agreement was high: consistency ICC 0.77 (CI 95% 0.32-0.92) and absolute ICC 0.78 (CI 95% 0.34-0.93). Inter-observer agreement was high for the definition of thin pleural line as less than 1 mm.

Conclusions: TN and asymptomatic PTN have similar PLT values. Overall, PLT in healthy newborns should be less than 1 mm.

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