A Lung Ultrasound Severity Score Predicts Chronic Lung Disease in Preterm Infants

Abstract

Objective To test the hypothesis that a lung ultrasound severity score (LUSsc) can predict the development of chronic lung disease (CLD) in preterm neonates. Study Design Preterm infants <30 weeks' gestational age were enrolled in this study. Lung ultrasound (LUS) was performed between 1 and 9 postnatal weeks. All ultrasound studies were done assessing three lung zones on each lung. Each zone was given a score between 0 and 3. A receiver operating characteristic curve was constructed to assess the ability of LUSsc to predict CLD. Results We studied 27 infants at a median (interquartile range [IQR]) gestational age and birth weight of 26 weeks (25–29) and 780 g (530–1,045), respectively. Median (IQR) postnatal age at the time of LUS studies was 5 (2–8) weeks. Fourteen infants who developed CLD underwent 34 studies. Thirteen infants without CLD underwent 30 studies. Those who developed CLD had a higher LUSsc than those who did not (median [IQR] of scores: 9 [6–12] vs. 3 [1–4], p < 0.0001). An LUSsc cutoff of 6 has a sensitivity and specificity of 76 and 97% and positive and negative predictive values of 95 and 82%, respectively. Adding gestational age < 27 weeks improved sensitivity and specificity to 86 and 98% and positive and negative predictive values to 97 and 88%. Conclusion LUSsc between 2 and 8 weeks can predict development of CLD in preterm neonates.

Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants

“…More recently, Abdelmawla et al retrospectively examined 27 patients born before 30 weeks’ GA, with 64 LUs and measured the LU score weekly, finding that a score higher than 5 between two and 8 weeks of life can predict moderate‐severe BPD . The discrepancy with our findings regarding the optimal values and timing for prediction, may be due to their inclusion of more immature infants (median GA at birth 26 weeks), possibly necessitating higher values to predict BPD.…”

“…Previous studies evaluating early signs in LU related to BPD, patients born before 30 weeks' GA, with 64 LUs and measured the LU score weekly, finding that a score higher than 5 between two and 8 weeks of life can predict moderate-severe BPD. 15 The discrepancy with our findings regarding the optimal values and timing for prediction, may be due to their inclusion of more immature infants Abbreviations: AUC, area under the curve; DOL, days of life; LR+, positive likelihood ratio; LR−, negative likelihood ratio; LUS, lung ultrasound score; OCP, optimal cuttoff point; PPN, negative predictive value; PPV, positive predictive value.…”

“…Bedside LU was performed using a high-frequency linear 8 to 15 MHz probe (Sonoscape Medical Corp., Shenzhen, China) with the probe held perpendicular to the ribs. All LUs were performed by the attending physician and were recorded anonymously.…”

“…Two studies have shown that persistent retrodiaphragmatic hyperechogenicity in the subcostal view after 9 or 18 days of life (DOL) predicted the development of BPD in VLBWI. A semiquantiative lung ultrasound score (LU score), adapted from adult studies, has been proposed as a predictor of BPD from 2 to 8 weeks of life in VLBWI . While promising, research regarding LU in BPD is otherwise scarce.…”

“…A semiquantiative lung ultrasound score (LU score), adapted from adult studies, has been proposed as a predictor of BPD from 2 to 8 weeks of life in VLBWI. 15 While promising, research regarding LU in BPD is otherwise scarce. In this study we aim to describe LU score evolution in VLBWI with and without BPD and assess whether it is useful as a BPD predictor.…”