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Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study
  1. Douglas A Blank1,2,
  2. C Omar Farouk Kamlin1,
  3. Sheryle R Rogerson1,
  4. Lisa M Fox1,
  5. Laila Lorenz1,3,
  6. Stefan Charles Kane4,5,
  7. Graeme R Polglase2,
  8. Stuart B Hooper2,
  9. Peter G Davis1
  1. 1Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
  2. 2The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
  3. 3Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
  4. 4Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr. Douglas A Blank, Newborn Research Centre, 7th Floor, The Royal Women's Hospital Cnr Grattan Street & Flemington Road, Parkville, VIC, Australia 3052; douglas.blank{at}


Objective Lung ultrasound (LUS) has shown promise as a diagnostic tool for the evaluation of the newborn with respiratory distress. No study has described LUS during ‘normal’ transition. Our goal was to characterise the appearance of serial LUS in healthy newborns from the first minutes after birth until airway liquid clearance is achieved.

Study design Prospective observational study.

Setting Single-centre tertiary perinatal centre in Australia.

Patients Of 115 infants born at ≥35 weeks gestational age, mean (SD) gestational age of 386/7 weeks±11 days, mean birth weight of 3380±555 g, 51 were delivered vaginally, 14 via caesarean section (CS) after labour and 50 infants via elective CS.

Interventions We obtained serial LUS videos via the right and left axillae at 1–10 min, 11–20 min and 1, 2, 4 and 24 hours after birth.

Main outcome measures LUS videos were graded for aeration and liquid clearance according to a previously validated system.

Results We analysed 1168 LUS video recordings. As assessed by LUS, lung aeration and airway liquid clearance occurred quickly. All infants had an established pleural line at the first examination (median=2 (1–4) min). Only 14% of infants had substantial liquid retention at 10 min after birth. 49%, 78% and 100% of infants had completed airway liquid clearance at 2, 4 and 24 hours, respectively.

Conclusions In healthy transitioning newborn infants, lung aeration and partial liquid clearance are achieved on the first minutes after birth with complete liquid clearance typically achieved within the first 4 hours of birth.

Trial registration number ANZCT 12615000380594.

  • Neonatology
  • lung liquid
  • lung aeration
  • lung ultrasound
  • newborn

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  • Contributors All authors have made significant contributions to the conception and design of the study, acquisition of data, data analysis and interpretation, drafting and revising the manuscript and final approval. All research was conducted at the Royal Women’s Hospital, Melbourne, Victoria, Australia. DAB wrote the first draft of the manuscript. No author received payment to produce the manuscript. All authors have reviewed and approve of the submitted version of the manuscript and they take full responsibility for the content.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Ethics approval The Royal Women's Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.