Echography-Guided Surfactant Therapy to Improve Timeliness of Surfactant Replacement: A Quality Improvement Project

Raschetti, Roberto; Yousef, Nadya; Vigo, Giulia; Marseglia, Gian Luigi; Centorrino, Roberta; Ben-Ammar, Rafik; Shankar-Aguilera, Shivani; Luca, Danièle De

doi:10.1016/j.jpeds.2019.04.020

Cited by 101 publications

(123 citation statements)

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“…Table is not comprehensive, but it is out of the scope of this article to list all LUS validation studies. Conversely, even with its semiquantitative nature and intrinsic limitations, evidence‐based data from our group and others have clearly demonstrated the diagnostic accuracy of LUS to predict a surfactant need in preterm neonates with respiratory distress syndrome, and these data have also been recently meta‐analyzed, confirming their high accuracy …”

Section: Examples Of Studies Validating Lus Scores Against Various Mementioning

confidence: 57%

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

Luca

2019

J of Ultrasound Medicine

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Section: Examples Of Studies Validating Lus Scores Against Various Mementioning

confidence: 57%

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

Luca

2019

J of Ultrasound Medicine

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“…[5][6][7][8][9] In a recent pilot study published in this volume of The Journal, Raschetti et al address the above question as a quality improvement project using either a lung ultrasound score or FiO 2 thresholds compared with FiO 2 thresholds only, to guide surfactant replacement therapy. 10 This study demonstrated that echography-guided surfactant therapy (ESTHER) improves the timeliness of surfactant administration in neonates born £32 weeks of gestation with RDS. 10 In this study, in the first 6 months of the "Plan-Do-Study-Act" cycle, surfactant was administered in the first 72 hours of life if the FiO 2 increased above 0.3 for infants £28 6/7 weeks and…”

mentioning

confidence: 87%

“…10 This study demonstrated that echography-guided surfactant therapy (ESTHER) improves the timeliness of surfactant administration in neonates born £32 weeks of gestation with RDS. 10 In this study, in the first 6 months of the "Plan-Do-Study-Act" cycle, surfactant was administered in the first 72 hours of life if the FiO 2 increased above 0.3 for infants £28 6/7 weeks and…”

mentioning

confidence: 87%

“…The proportion of neonates who received surfactant within the first 3 hours of life was significantly increased (71%-90%; P < .001) and the maximal FiO 2 reached was reduced before surfactant replacement therapy (33%-40%). 10 The authors did not find any difference in the overall need for surfactant. 10 In addition to this, the Raschetti et al study also mentioned that there was a reduction in the need for invasive ventilation and increased ventilator-free days in the ESTHER group.…”

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confidence: 89%

“…10 In the second half of the study period, ESTHER criteria were used for surfactant administration including exceeding FiO 2 limits as above or the lung ultrasound score higher than 8, whichever occurred first. 10 It is not explicitly stated if this was irrespective of the type of respiratory support, though it is implied that the infant would be on CPAP in all instances. It is also not clear if the lung ultrasound was performed at specific times after the birth of the baby, which would obviously impact on the lung ultrasound score.…”

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confidence: 99%

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Use of Lung Ultrasound to Improve Timeliness of Surfactant Replacement in Respiratory Distress Syndrome: Are we Ready?

Lodha

Bhandari

2019

The Journal of Pediatrics

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Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later

De Luca,

Bonadies,

Alonso-Ojembarrena

et al. 2024

JAMA Netw Open

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ImportanceSurfactant administration may be needed in late preterm through full-term neonates, but the pathophysiology of their respiratory failure can be different from that of early preterm neonates. The lung ultrasonography score (LUS) is accurate to guide surfactant replacement in early preterm neonates, but to our knowledge, it has not yet been studied in the late preterm through full-term neonatal population.ObjectiveTo assess whether LUS is equally accurate to predict surfactant need in late preterm through full-term neonates as in early preterm neonates.Design, Setting, and ParticipantsThis prospective, international, multicenter diagnostic study was performed between December 2022 and November 2023 in tertiary academic neonatal intensive care units in France, Italy, Spain, and the US. Late preterm through full-term neonates (≥34 weeks’ gestation) with respiratory failure early after birth were enrolled.ExposurePoint-of-care lung ultrasonography to calculate the neonatal LUS (range, 0-18, with higher scores indicating worse aeration), which was registered in dedicated research databases and unavailable for clinical decision-making.Main Outcomes and MeasuresThe main outcomes were the area under the curve (AUC) in receiver operating characteristic analysis and derived accuracy variables, considering LUS as a replacement for other tests (ie, highest global accuracy) and as a triage test (ie, highest sensitivity). Sample size was calculated to assess noninferiority of LUS to predict surfactant need in the study population compared with neonates born more prematurely. Correlations of LUS with the ratio of hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) to fraction of inspired oxygen (FiO2) and with the oxygen saturation index (OSI) were assessed.ResultsA total of 157 neonates (96 [61.1%] male) were enrolled and underwent lung ultrasonography at a median of 3 hours (IQR, 2-7 hours) of life; 32 (20.4%) needed surfactant administration (pretest probability, 20%). The AUC was 0.87 (95% CI, 0.81-0.92). The highest global accuracy and sensitivity were reached for LUS values higher than 8 or 4 or lower, respectively. Subgroup analysis gave similar diagnostic accuracy in neonates born late preterm (AUC, 0.89; 95% CI, 0.81-0.97; n = 111) and early term and later (AUC, 0.84; 95% CI, 0.73-0.96; n = 46). After adjusting for gestational age, LUS was significantly correlated with SpO2:FiO2 (adjusted β, −10.4; 95% CI, −14.0 to −6.7; P &lt; .001) and OSI (adjusted β, 0.2; 95% CI, 0.1-0.3; P &lt; .001).Conclusions and RelevanceIn this diagnostic study of late preterm through full-term neonates with respiratory failure early after birth, LUS accuracy to predict surfactant need was not inferior to that observed in earlier preterm neonates. An LUS higher than 8 was associated with highest global accuracy (replacement test), suggesting that it can be used to guide surfactant administration. An LUS value of 4 or lower was associated with the highest sensitivity (triage test), suggesting it is unlikely for this population to need surfactant.

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Echography-Guided Surfactant Therapy to Improve Timeliness of Surfactant Replacement: A Quality Improvement Project

Cited by 101 publications

References 37 publications

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

Semiquantititative lung ultrasound scores are accurate and useful in critical care, irrespective of patients’ ages: The power of data over opinions

Use of Lung Ultrasound to Improve Timeliness of Surfactant Replacement in Respiratory Distress Syndrome: Are we Ready?

Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later

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