Lung ultrasound immediately after birth predicts the need for surfactant therapy in very- and extremely preterm infants, the DOLFIN Jr Study

Abstract

BackgroundEarly identification of infants requiring surfactant therapy improves outcomes. We evaluated the accuracy of delivery room lung ultrasound (LUS) to predict surfactant therapy in very- and extremely preterm infants.MethodsInfants born at <320/7 weeks were prospectively enrolled with parental consent at 2 centres. LUS videos of both sides of the chest were obtained 5-10 minutes, 11-20 minutes, and 1-3 hours after birth. Clinicians were masked to the results of the LUS assessment and surfactant therapy was provided according to local guidelines. LUS videos were graded blinded to clinical data. Presence of unilateral type 1 (‘whiteout’) LUS or worse was considered test positive. Receiver Operating Characteristic (ROC) analysis compared the accuracy of LUS and an FiO2 threshold of 0.3 to predict subsequent surfactant therapy.ResultsFifty-two infants with a median age of 276/7 weeks (IQR 260/7 to 286/7) were studied. Thirty infants (58%) received surfactant. Area under the ROC curve (AUC) for LUS at 5-10 minutes, 11-20 minutes and 1-3 hours was 0.78 (95% CI, 0.66–0.90), 0.76 (95% CI, 0.65-0.88) and 0.86 (95% CI, 0.75-0.97) respectively, outperforming FiO2 at the 5-10 minute timepoint (AUC 0.45, 95% CI 0.29-0.62, p=0.001). At 11-20 minutes, LUS had a specificity of 95% (95% CI 77-100%) and sensitivity of 59% (95% CI, 39-77%) to predict surfactant therapy. All infants born at 23-276/7 weeks with LUS test positive received surfactant. Twenty-six infants (50%) had worsening of LUS grades on serial assessment.ConclusionsLUS in the delivery room is feasible and accurately predicts surfactant therapy in infants <320/7 weeks. Study registration: ACTRN12617001256369