Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

Oulego-Erróz, Ignacio; Alonso-Quintela, Paula; Terroba-Seara, Sandra; Jiménez-Gónzález, Aquilina; Rodríguez-Blanco, Silvia

doi:10.1038/s41372-020-0724-z

Cited by 47 publications

(46 citation statements)

References 41 publications

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“…In fact, in our study, VPI evolving to BPD with clinically significant hs-PDA were likely to be treated, but when adjusting for confounders, a treated hs-PDA was no longer significant. Oulego-Erroz et al [17] also found an excellent AUC for the LUS score to predict moderate-severe BPD with a cutoff point ≥8. The good performance of their score may be due to a higher correlation with days of MV because it assessed more posterior fields and included few patients with mild BPD.…”

Section: Discussionmentioning

confidence: 89%

“…It can assess dynamic changes over time and often detect them earlier than CXR. Recently, LUS has proven to be useful for respiratory management in VPI [16] and seems to be a promising tool for BPD [17][18][19]. In this study, we aim to compare LUS findings according to the diagnosis of BPD in VPI and to identify early clinical and echographic markers of BPD development in these patients.…”

Section: Introductionmentioning

confidence: 99%

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Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

et al. 2021

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Introduction: Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. Methods: Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. Results: Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79–0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70–0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84–0.97), p < 0.001. Conclusion: LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

et al. 2021

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“…Lung ultrasound (LU) is proving to be very useful in Neonatal Intensive Care Units (NICU): it diagnoses respiratory diseases with a higher accuracy than X‐ray, 1‐3 it predicts the need for admission for neonatal patients 4 and noninvasive ventilation failure, 5,6 and even the need for surfactant in preterm 7 and very low birth weight infants 8 . It also predicts bronchopulmonary dysplasia (BPD) in very low birth weight infants in the first week of life 9‐11 . Therefore, it is a harmless and easy‐to‐learn technique with high intraobserver and interobserver agreement 12 .…”

Section: Introductionmentioning

confidence: 99%

Lung ultrasound score and diuretics in preterm infants born before 32 weeks: A pilot study

Alonso‐Ojembarrena

Morales-Arandojo

Acuñas-Soto

et al. 2020

Pediatric Pulmonology

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Objective To describe if weekly determined lung ultrasound (LU) scores in preterm infants born before 32 weeks (PTB32W) change with diuretic therapy. Design We included infants who received diuretics and compared LU scores according to their evolution on respiratory support (RS) before and after diuretics. Results We included 18 PTB32W divided into two groups. Both groups were similar in terms of median gestational age: 26 weeks (interquartile range [IQR]: 25–28) in the responders' group and 27 weeks (IQR: 24–28) in the other. They differed, however, in the median number of days on invasive mechanical ventilation: 27 (IQR: 11–43) versus 76 (IQR: 35–117), p = .03; in addition to the number of infants with moderate‐severe bronchopulmonary dysplasia: 3 (33%) versus 8 (89%), p = .025. The responders' group showed lower LU scores 2 days after diuretics, with a median LU score of 6 (IQR: 3–12) versus 14 (IQR: 12–17) in the nonresponders group, p = .03; 1 week after (3 [IQR: 0–10] versus 12 [12–12], p = .04); and 3 weeks after (5 [IQR: 3–6] versus 12 [10–15], p = .01). RS also decreased at the same time: 7 out of 9 (78%) were extubated in the responders' group, and 1 out of 9 (11%) in the nonresponders group, p = .02, and these differences remained throughout the entire follow‐up. Conclusions There is a group of PTB32W patients whose LU score improves after diuretics. This change appears only in those patients that can be weaned off from RS, and at the same period of time as the administration of diuretics.

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“…The results of lung ultrasound have high diagnostic value in predicting the risk of developing BPD, but only after 1 week of life [ 27 ]. Despite the diagnostic value of echocardiography and lung ultrasound, the interpretation of the results of both these examinations is subjective, requires involvement of skilled specialists, and the examination itself requires additional costs.…”

Section: Discussionmentioning

confidence: 99%

Patent ductus arteriosus, systemic NT-proBNP concentrations and development of bronchopulmonary dysplasia in very preterm infants: retrospective data analysis from a randomized controlled trial

2021

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Background Patent ductus arteriosus (PDA) is a common complication in very preterm infants. It is known that there is an association between PDA and development of bronchopulmonary dysplasia (BPD) or death before the postmenstrual age (PMA) of 36 weeks, but this association remains one of the most controversial aspects of the problem. The study aimed to evaluate the relationship between PDA, serum NT-proBNP levels at 2–3 and 8–9 days of life, and BPD/death in very preterm infants. Methods Data of 52 preterm infants with a gestational age < 32 weeks, chronological age < 72 h, and PDA diameter > 1.5 mm, enrolled in a randomized controlled trial, were used for the retrospective analysis. All patients underwent daily echocardiographic and two serum NT-proBNP measurements within the first 10 days after birth. Two groups of infants were formed retrospectively at PMA of 36 weeks depending on the outcome, BPD (n = 18)/death (n = 7) or survival without BPD (n = 27). Receiver operator characteristic (ROC) curve was used to evaluate the predictive performance of serum NT-proBNP levels for BPD/death occurrence. Results The percentage of infants who received pharmacological treatment for PDA did not differ between the groups. Based on the area under the ROC curve, serum NT-proBNP levels on the 2–3 day of life (AUC = 0.71; 95% confidence interval (CI): 0.56–0.9; p = 0.014)) and on the 8–9 day of life (AUC = 0.76; 95% CI: 0.6–0.9; p = 0.002) could reliably predict BPD/death in very preterm infants who had PDA diameter > 1.5 mm in the first 72 h of life. Hemodynamically significant PDA (hsPDA) was significantly more often detected in newborns with BPD/death, however, treatment of infants with hsPDA did not reduce the incidence of BPD/death. Conclusions In very preterm infants with PDA > 1.5 mm at the age of 24–48 h, serum NT-proBNP concentration could reliably predict the development of BPD or death, regardless of the persistence of PDA, with the highest diagnostic value at 8–9 days. Trial registration This study is registered in ClinicalTrials.gov - NCT03860428 on March 4, 2019.

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Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

Cited by 47 publications

References 41 publications

Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Lung ultrasound score and diuretics in preterm infants born before 32 weeks: A pilot study

Patent ductus arteriosus, systemic NT-proBNP concentrations and development of bronchopulmonary dysplasia in very preterm infants: retrospective data analysis from a randomized controlled trial

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