Neonatal lung ultrasonography score after surfactant in preterm infants: A prospective observational study

Abstract

ObjectiveTo assess changes in neonatal lung ultrasonography score (nLUS) after surfactant administration in preterm infants with respiratory distress syndrome (RDS).Working HypothesisThe reduction of nLUS score before (nLUSpre), 2 hours (nLUS2h), and 12 hours (nLUS12h) after surfactant administration to identify patients who will not need a second treatment.Study Design and SettingProspective observational study in the tertiary neonatal intensive care unit.Patients SelectionForty‐six preterm neonates with RDS of 32 weeks median gestational age (IQR 30‐33) and mean birth weight of 1650 ± 715 g.MethodologyLung ultrasonography was performed before, 2 hours, and 12 hours after surfactant administration in preterm infants with RDS needing surfactant treatment. Resulting nLUS was analyzed.ResultsThe Wilcoxon signed‐rank test demonstrated an nLUS lowering after 2 hours (P < .001) and 12 hours (P < .001) from surfactant administration. Sixteen newborns required surfactant retreatment with median gestational age of 32 weeks (IQR 29‐33) and mean birth weight of 1519 ± 506 g.The receiver operating characteristic analysis for the nLUS2h yielded an area under the curve of 0.80 (95% confidence interval, 0.76‐0.85; P < .001). A nLUS2h ≥7 showed a sensitivity of 94% and a specificity of 60% for needing a second treatment with surfactant.ConclusionsIn preterm infants with RDS requiring surfactant treatment, nLUS evaluated 2 hours after surfactant administration can be used to identify patients who will not need a second treatment.

The Role of Lung Ultrasound as an Early Diagnostic Tool for Need of Surfactant Therapy in Preterm Infants with Respiratory Distress Syndrome

“…It was 39.4% (n ¼ 13) in the mild RDS group and 100% (n ¼ 12) in the severe RDS group. The patients achieved a median maximum FiO 2 level of 35% (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) when the first dose of surfactant was administered and had a 50% reduced need for oxygen after the treatment (considering a response to treatment as reduction of at least 20% of the previous FiO 2 level). The LUS score median value on admission to the NICU was 5 (2-10) and the SaO 2 /FiO 2 ratio was 161 (148-310).…”

Lung ultrasound in the neonatal intensive care unit: Review of the literature and future perspectives

“…This study showed that in preterm infants with RDS a LU score 2 hours after surfactant administration can be useful in identifying patients who will need a second treatment. In particular, a score greater than or equal to 7 showed a sensitivity of 94%, a specificity of 60%, a NPV of 95%, and a PPV of 56%.⁠ 46 …”

“…A recent paper published by Perri et al 46 explored the change in LU score after 2 hours from surfactant administration. The score utilized divided the chest into the same areas as the score by Brat et al 41 with minimal changes on attribution of the score for a single area.…”

Neonatal RDS and LUS, is the debate still open?

“…by Quarato et al and we are pleased by the interest directed to our article "Neonatal lung ultrasonography score after surfactant in preterm infants: A prospective observational study" published on your journal. 1 This study included preterm neonates with respiratory distress syndrome (RDS) who required noninvasive ventilation and surfactant. The aim of our study was to assess changes in a validated neonatal lung ultrasonography score (nLUS) after surfactant treatment.…”