Lung Ultrasound Score Progress in Neonatal Respiratory Distress Syndrome

Abstract

BACKGROUND AND OBJECTIVES: The utility of a lung ultrasound score (LUS) has been described in the early phases of neonatal respiratory distress syndrome (RDS). We investigated lung ultrasound as a tool to monitor respiratory status in preterm neonates throughout the course of RDS. METHODS: Preterm neonates, stratified in 3 gestational age cohorts (25–27, 28–30, and 31–33 weeks), underwent lung ultrasound at weekly intervals from birth. Clinical data, respiratory support variables, and major complications (sepsis, patent ductus arteriosus, pneumothorax, and persistent pulmonary hypertension of the neonate) were also recorded. RESULTS: We enrolled 240 infants in total. The 3 gestational age intervals had significantly different LUS patterns. There was a significant correlation between LUS and the ratio of oxygen saturation to inspired oxygen throughout the admission, increasing with gestational age (b = −0.002 [P < .001] at 25–27 weeks; b = −0.006 [P < .001] at 28–30 weeks; b = −0.012 [P < .001] at 31–33 weeks). Infants with complications had a higher LUS already at birth (12 interquartile range 13–8 vs 8 interquartile range 12–4 control group; P = .001). In infants 25 to 30 weeks’ gestation, the LUS at 7 days of life predicted bronchopulmonary dysplasia with an area under the curve of 0.82 (95% confidence interval 0.71 to 93). CONCLUSIONS: In preterm neonates affected by RDS, the LUS trajectory is gestational age dependent, significantly correlates with the oxygenation status, and predicts bronchopulmonary dysplasia. In this population, LUS is a useful, bedside, noninvasive tool to monitor the respiratory status.

Neonatal pulmonary hypertension after severe early-onset fetal growth restriction: post hoc reflections on the Dutch STRIDER study

“…Furthermore, other potential useful diagnostics, such as lung X-rays and lung ultrasounds, have not been performed and collected systematically. Especially the role of lung ultrasound in this patient group would have been interesting, since this might be a promising technique in diagnosing PPHN and provide insight in the underlying cause [20][21][22].…”

Lung Ultrasound in the Neonatal Intensive Care Unit: Does It Impact Clinical Care?

“…Lung Ultrasound Score LUS scores provide a standardized approach for a semi-quantitative assessment of neonatal lung pathology and the progression of disease [2,[11][12][13][14]. Neonatal LUS score is commonly calculated by six chest areas that interrogate the anterior and lateral chest.…”

“…The common modes used in LUS are 2D B-mode (brightness) and M-mode (motion), with an expanded use of a color doppler to evaluate blood flow [ 9 ]. The neonatal LUS is typically performed supine with direct identification of subcutaneous tissue, ribs, pleural line, and lung sliding with indirect evaluation of lung tissue [ 11 ].…”

“…Each zone is assigned a score of 0 to 3, with total score between 0 and 18. The number of B-lines and subpleural consolidations per lung zone help distinguish different neonatal respiratory pathologies [ 11 ]. This approach to LUS is reproducible, with a high inter-observer agreement [ 15 ] and has the potential to be used to guide management and risk stratify neonates [ 7 ].…”

World Prematurity Day: the long journey of the preterm lung

“…The identification of early-risk markers of developing diseases is still crucial in neonatology. An interesting promising tool for this purpose is lung ultrasound, which has demonstrated a good predictor for identifying infants that will develop BPD even as early as 3 days after birth (2,22,32). Other predictive tools and therapies are also needed with regard to the other complications linked to prematurity, and to do so we will need to better understand the pathogenetic mechanism underlying them.…”