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

Abstract

Objective This study aimed to determine the accuracy of neonatal lung ultrasound (LUS) in predicting the need for surfactant therapy compared with chest X-ray (CXR) in preterm infants. Study Design A prospective double-blind study was conducted in infants with a gestational age <34 weeks with respiratory distress syndrome (RDS) by evaluation with LUS and CXR on admission. Results Among 45 preterm infants, the median (interquartile range [IQR]) LUS score was 4 (2–8) in the mild RDS group, whereas it was 10 (IQR: 9–12) in the severe RDS group (p < 0.01). The LUS score showed a significant correlation with the need for total surfactant doses (ρ = 0.855; 95% confidence interval [CI]: 0.801–0.902; p < 0.001). A cut-off LUS score of four predicted the need for surfactant with 96% sensitivity and 100% specificity (area under the curve [AUC]: 1.00; 95% CI: 0.97–1.00; p < 0.01). LUS scores predicted continuous positive airway pressure (CPAP) failure accurately (AUC: 0.804; 95% CI: 0.673–0.935; p = 0.001). A significant correlation was observed between LUS scores and positive end-expiratory pressure levels (ρ = 0.782; p < 0.001). During the study period, the CXR number per infant with RDS decreased significantly when compared with preceding months (p < 0.001). The LUS score in the first day of life did not predict the development of bronchopulmonary dysplasia (AUC: 0.274; 95% CI: 0.053–0.495; p = 0.065). Conclusion The LUS score in preterm infants accurately predicts the severity of RDS, the need for surfactant and CPAP failure. The routine use of LUS can decrease the frequency of CXRs in the neonatal intensive care units. Key Points

Ultrasound performed shortly after birth can predict the respiratory support needs of late preterm and term infants: A diagnostic accuracy study

“…Brat et al 21 developed a semiquantitative scoring system to predict PS application on early preterm infants. While other studies confirmed Brat's findings, 22,23 their scoring system seems too complicated to be practical in some cases due to the restless motion of infants. Raimondi et al 24,25 adopted simply three straightforward LUS patterns to predict NICU admission or the need for intubation, but it seems a crucial pathological pattern—“consolidation”—is absent from their criteria.…”

“…Recent studies have also paid attention to the predictive value, 21–23,40 especially for PS needs in very preterm infants. In comparison, we studied the need for varieties kinds of respiratory support, including CPAP and MV, which are related to a broader spectrum of respiratory issues.…”

Roles of Lung Ultrasound Score in the Extubation Failure From Mechanical Ventilation Among Premature Infants With Neonatal Respiratory Distress Syndrome

“…Previous studies reported that LUS has good diagnostic accuracy and specificity in comparison with chest X-ray, especially for the quantitative diagnosis of neonatal RDS ( 24 , 25 ). To date, LUS-related studies focused on the predictive values of LUS in need for surfactants and the severity of neonatal RDS ( 15 , 26 ). Nonetheless, few studies assessed the role of LUS in the weaning off from MV among babies with RDS.…”

Personalized Medicine for the Management of RDS in Preterm Neonates

“…Functional lung ultrasound has been used as a point-of-care imaging tool to monitor acute respiratory failure in adults since decades, but it has only recently been introduced in neonatology [33]. The technique has been used to predict CPAP failure and surfactant need through a simple and qualitative evaluation of lung ultrasound findings [34][35][36] or the calculation of a quantitative lung ultrasound score (LUS) modified from adult experience and specifically validated in neonates [37][38][39][40][41][42]. Lung ultrasound has always been performed in the first hours of life.…”

“…a-c Sensitivity, specificity, and AUC, respectively. LUS data are those derived from the meta-analyses of all diagnostic accuracy studies[37][38][39][40][41][42] on this technique (see Fig.2). Data on chest X-rays, LBC, SAT, and SMT are extracted from Perri et al[39], Raschetti et al[66], Autilio et al[76], and Bhatia et al[80], respectively.…”