Prone versus Supine Position for Lung Ultrasound in Neonates with Respiratory Distress

Abstract

Objective To study the feasibility of lung ultrasound (LUS) in prone position and to compare it with supine position in neonates with respiratory distress. Study Design Neonates ≥ 29 weeks of gestational age with respiratory distress requiring respiratory support within first 12 hours of life were enrolled prospectively. First LUS (fLUS) was done in the position infant was nursed (supine or prone), infant’s position changed, a second LUS (sLUS) was performed immediately and a third LUS (tLUS) was done 1 to 2 hours later. Primary outcome was the comparison of LUS scores (LUSsc) between fLUS and sLUS. Results Sixty-four neonates were enrolled. Common respiratory diagnoses were transient tachypnea of newborn (TTN; 53%) and respiratory distress syndrome (RDS; 41%). LUSsc was different between fLUS and sLUS (fLUSsc 6 [interquatile range: 4, 7] vs. sLUSsc 7 [4, 10], p < 0.001), while there was no difference between the fLUS and tLUS (fLUSsc 6 [4, 7] vs. tLUSsc 5 [3, 7], p = 0.43). Subgroup analysis confirmed similar findings in neonates with TTN, while in babies with RDS, all the three LUSsc were similar. Conclusion LUS is feasible in prone position in neonates. LUS scores were higher immediately after a change in position but were similar to baseline 1 hour after the change in position.

Lung ultrasound predicts histological lung injury in a neonatal model of acute respiratory distress syndrome

“…however, the posterior lung was assessed in a single posterolateral zone, as animals were maintained in the supine position, based on our previous report that change to prone position mid-study would require a subsequent 1 hour restabilization period. 35 In each zone, a US score of 0 = only horizontal A-lines; 1 = less than or equal to 3 well-spaced B-lines; 2 = crowded B-lines and/or subpleural consolidation; 3 = extended subpleural consolidation more than 1 cm, for a maximum US score of 24 for each animal. Due to the known heterogeneity of ALI, we also compared scores for each zone.…”

A Modified Lung Ultrasound Score for Assessing Oxygenation Status and Predicting the Need for Invasive Ventilation in Preterm Neonates with RDS

“…To date, several studies have been published assessing the clinical usefulness of lung ultrasound in newborns with respiratory disorders [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. These works focused mainly on preterm infants with RDS and transient tachypnea of the newborn (TTN); in both cases, LUS was performed primarily on the rst day of life.…”

“…In all reports concerning LUS in neonatal RDS, sonograms were limited to the early post-birth period, typically the rst 24 hours of life [1][2][3][4][5][6]. This early post-birth LUS proved to be well correlated with the gas exchange indices [1,6].…”

“…An increasing number of reports have recently been published on the usefulness of the lung ultrasound score (LUS) to assess lung function in premature infants with respiratory distress syndrome (RDS) [1][2][3][4][5][6][7].…”

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

“…A recent study compared LU score findings in the supine and prone positions 8 : the findings were equivalent one hour after the position change. Therefore, to minimize handling of the most unstable neonates, it may be advisable not to alter the neonate's position exclusively to perform LU.…”