Accuracy and Reliability of Lung Ultrasound to Diagnose Transient Tachypnoea of the Newborn: Evidence from a Meta-analysis and Systematic Review

Abstract

Objective Transient tachypnoea of the newborn (TTN) is one of the most common causes of neonatal respiratory distress (RD) during the newborn period. Chest radiography (CXR) is commonly used to rule out the diagnosis, but TTN is often misdiagnosed as neonatal respiratory distress syndrome (NRDS) on the basis of CXR alone. Increasing evidence suggests that lung ultrasound (LUS) may be a reliable diagnostic tool for transient tachypnoea of the newborn. However, studies of the diagnostic efficiency of LUS are still lacking. This study was aimed to evaluate the accuracy and reliability of LUS for diagnosing TTN by conducting a systematic review and meta-analysis. Study Design We searched for articles in the Embase, PubMed, and Cochrane Library databases from inception until May 31, 2020. The selected studies were diagnostic accuracy studies that reported the utility of LUS in the diagnosis of TTN. Two researchers independently extracted data and assessed quality using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Then, we created a bivariate model of mixed effects to calculate the sensitivity and specificity of LUS in diagnosing TTN. A summary receiver operator characteristic (SROC) curve was constructed to summarize the performance characteristics of LUS. Results Six studies involving 617 newborns were included in the review. LUS had a pooled sensitivity of 0.98 (confidence interval [CI]: 0.92–1.00) and a specificity of 0.99 (CI: 0.91–1.00). The area under the curve for LUS was 1.00 (0.98–1.0). Meta-regression revealed that LUS had a significant diagnostic accuracy for TTN. Conclusion The performance of ultrasound for the detection of TTN was excellent. Considering the various advantages of LUS compared with chest radiographs in diagnosing TTN, this study supports the routine use of LUS for the detection of TTN. Key Points

Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination

“…(A)The image from the high-end machine showed typical snowflake-like lung consolidations suggested RDS [35,42]. (B)The image from the low-end machine showed only coalescent B-lines suggested transient tachypnea of the newborn [18,43].…”

“…TGC is also known as distance gain compensation.When US waves propagate through tissues,the reflecting US signal attenuation gradually increases as the depth increases.The gain can be gradually enhanced from near-field to far-field by adjusting the TGC keys to obtain a uniform image during LUS examination [18,28] (Figure 11).…”

“…In addition,it played a crucial role in the disease follow up and facilitated NLDs management procedures [8][9][10][11][12].Due to the sharp learning curve, ease of use, minimization of overall radiation exposure, the application of LUS has significantly increased or even completely replaced chest X-rays (CXR) in some neonatal intensive care units (NICU) across the world [13][14][15]. Widespread adoption of LUS requires structured education and accurate, and reliable image technical characteristics [16][17][18][19].…”

Lungenultraschall in der Neonatologie

“…Für das Atemnotsyndrom des Neugeborenen liegen die Sensitivität bei 92–99 % und die Spezifität bei 95 % 13 14 . Für die transitorische Tachypnoe des Neugeborenen liegen die Sensitivität bei 98 % und die Spezifität bei 99 % 15 . Während beide Krankheitsbilder mit konfluierenden B-Lines in den ersten Lebensstunden beginnen, kommt es bei der transitorischen Tachypnoe des Neugeborenen in Rückenlage zuerst in den ventralen Arealen zu einer Flüssigkeitsresorption und damit zu einer besseren Belüftung, wohingegen die dorsobasalen Areale weiterhin vermehrte bis hin zu konfluierenden B-Lines aufweisen – dies bezeichnet man als Double Lung Point ( Abb.…”

The Value of Lung Ultrasound Score in Neonatology

“…Moreover, LUS is known to have a steep learning curve and is easy to learn ( 4 ). LUS significantly improves the diagnosis and differential diagnosis of various neonatal respiratory diseases ( 5 , 6 ). Importantly, chest X-ray (CXR) examinations in the NICU were significantly reduced.…”