Traditionally, the diagnosis of lung diseases has primarily relied on chest X-ray (CXR) or even CT examination results, which are considered the “Gold Standard” for lung disease diagnosis; in comparison, lung ultrasound (LUS) is considered a “forbidden zone” for diagnosing lung diseases

Lung ultrasound (LUS) is being increasingly used to diagnose neonatal pneumonia. However, whether LUS can distinguish between infectious pneumonia (IP) and

Background Lung ultrasound (LUS) is widely used in the management of neonatal pneumonia, our previous research has confirmed that LUS cannot identify the etiologies of neonatal pneumonia. However, there is still controversy and confusion regarding whether LUS can differentiate between different types of pneumonia (such as intrauterine infectious pneumonia (IP), ventilator-associated pneumonia (VAP), community-acquired pneumonia (CAP), meconiumaspiration pneumonia (MAP)). Therefore, we have organized this prospective multicenter study to address and answer these remaining questions. Methods A prospective approach was used to collect LUS data on neonatal all kinds of pneumonia from 5 tertiary hospitals in China. The patients were devided into three categories: based on whether there is evidence of infection,ventilator treatment ot the history of meconium aspiration, they are classified as IP and non-IP, VAP and non-VAP, MAP and non-MAP. The major LUS imaging characteristics and complications were compared among groups. Results A total of 235 patients with neonatal pneumonia were included, comprising 195 patients with IP and 40 patients with non-IP. The ultrasound characteristics included pleural line abnormalities in all 235 patients, involving zones 1–12;B-lines in 174 patients, involving zones 1–12;lung consolidation in all 235 patients, involving zones 1–12%; pneumothorax in 4 patients; and pleural effusion in 31 patients.No significant differences in ultrasound characteristics were found between patients with MAP and patients with non-MAP or between patients with-or without VAP.Compared with IP,aspiration pneumonia was associated with a significantly greater incidence of right lung consolidation (100% vs. 89.2%),with no significant differences in other ultrasound signs. Conclusion The results of this study show that the most common ultrasound imaging manifestations of various etiologies of pneumonia in newborns are lung consolidation accompanied by airbronchograms.Differentiating between various types of pneumonia still requires the combination of medical history and relevant laboratory tests.

Severe pulmonary diseases, including atelectasis, pneumonia, and meconium aspiration syndrome, are major causes of neonatal respiratory distress, weaning difficulties, ventilator or oxygen dependence, prolonged oxygen requirements, extended hospitalization, and poor prognosis. The lack of simple and effective treatment strategies seriously endangers the survival and health of newborns, particularly premature infants. Recent advances in lung ultrasound (LUS) technology have made LUS-guided non-fiberobronchoscopic bronchoalveolar lavage (NFB-BAL) a promising solution. This approach addresses the limitations of conventional BAL in neonates by enabling accurate diagnosis, precise lesion localization, and dynamic procedural monitoring, hence reducing complications. Based on international expert consensus, these guidelines were developed to improve knowledge and promote the application of this technology and enhance operational standardization to ensure its effectiveness and safety. These guidelines contain 17 recommendations on 13 key clinical issues for reference and implementation in clinical practice. The wide application of these guidelines is expected to help significantly improve the prognosis of critically ill newborns with atelectatic pulmonary diseases.