الفهرس 
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Abstract
SUMMARY
Respiratory distress is one of the most common chief complaints for which children seek medical care. Respiratory compromise in children particular neonates must be recognized and aggressively treated because neonates may become fatigued and/or decompensated .
Neonatal respiratory distress syndrome (RDS) is the most common cause of respiratory distress in neonates also known as hyaline membrane disease, is a condition of increasing respiratory distress, commencing at/or shortly after birth and increases in severity until progressive resolution among the survivors, usually between the 2nd and 4th day .
The second common cause of respiratory distress in neonates Pneumonia , is one of the major worldwide health problems in children. It has been the cause of more deaths in pediatric age group Up to 53% of 2 hospitalized cases are complicated by parapneumonic effusion .
For many years transthoracic ultrasound limited exclusively to the examination of pleural effusion. However over the past few years ultrasonography of pleural space and lung parenchyma is gaining consensus in different conditions in clinical practice particulary in emergency conditions .
Respiratory distress in the newborn is recognized as one or more signs of increased work of breathing, such as tachypnea, nasal flaring, chest retractions, or grunting. Normally the newborn’s respiratory rate is 30 to 60 breaths per minute. Tachypnea is defined as a respiratory rate greater than 60 breaths per minute. Tachypnea is a compensatory mechanism for hypercarbia, hypoxemia, or acidosis (both metabolic and respiratory), making it a common but nonspecific finding in a large variety of respiratory, cardiovascular, metabolic, or systemic diseases. Pulmonary disease may incite tachypnea, especially in neonates. The natural elastic property of the lungs is to deflate.
Common causes of respiratory distress: Transient Tachypnea of the Newborn(TTN) ,RDS and Pneumonia.
Chest ultrasound allows prompt management based upon reproducible data and generates fewer computed tomography (CT) examinations, therefore decreasing irradiation, delays, cost and discomfort to the patient.
Recently, chest ultrasound has become an attractive new tool for assessing lung status in ventilated critically ill patients, as suggested by the increasing number of articles written about it by physicians practicing in chest, intensive care or emergency medicine. As a matter of fact, chest ultrasound can be used easily at the bedside to assess initial lung morphology in severely hypoxemic patients and can be easily repeated, allowing the effects of therapy to be monitored.
The normal pediatric lung picture does not differ from that of the adult lung. The superficial layers of the thorax consist of subcutaneous tissues and muscles. The ribs, on longitudinal scan, appear as curvilinear structures associated with posterior acoustic shadowing . The ribs and the pleural line, in the longitudinal view, outline a characteristic pattern, the “bat sign.
The pleura appears as a regular echogenic line (pleural line) moving continuously during respirations . Pleural movement has been described as the “lung sliding” sign. The amplitude of the lung sliding is minimal at the apices and maximal at the bases. Lung sliding can be objectified and documented with M-mode.
This study is a descriptive comparative study that was chosen randomly from pediatric department Beni- suef university on 25 patients in Neonatal Intensive Care unit suffering from respiratory distress, after explaining and taken informed consent from their parents neonates with and exclusion of with congenital heart disease.
Full history taking and Clinical examination including vital signs ,Lungs: Respiratory rate, presence or absence of retractions and grunting, air entry, additional sounds ,chest X ray and chest ultrasound.
In our study Most of babies was delivered preterm and we found strong correlation between cesarean delivery and respiratory distress especially RDS.
Chest radiography has been considered to be the standard radiological diagnostic tool for respiratory distress especially RDS and pneumonia which are the main component of respiratory distress, and the four-stage scale of RD severity based on radiographic findings correlates closely with the actual disease severity so X ray in our study was highly sensitive to detection of respiratory diseases.
According to the findings of our study, the main features of respiratory distress diseases can be visualized by ultrasound imaging include lung consolidation with air bronchograms, lung sliding, pleural effusion, bilateral white lung, B line ,A line and pneumothorax.
Chest ultrasound in our research showed strong positive role in diagnosis of respiratory diseases in neonates as data get it from ultrasound showed that there was a statistically significant strong agreement between ultrasound and X-ray diagnoses (P-value<0.001 and kappa=0.928).
Only one case in our study had respiratory distress by X ray and had respiratory distress complicated with thin rim of pleural effusion by chest ultrasound and this ultrasound finding was correlated with the clinical findings of this case in patient with grade II respiratory distress.