Early lung ultrasound affords little to the prediction of bronchopulmonary dysplasia

Woods, Patricia; Stoecklin, Benjamin; Woods, Amanda; Gill, Andrew

doi:10.1136/archdischild-2020-320830

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…GA remained the dominant predictor of msBPD, and adding LUSs or other clinical predictors in the first 2 weeks only marginally increased the AUROC curve; they were insufficient to reach statistical significance at any time point. Woods et al [ 11 ] prospectively enrolled 100 infants born at < 28 weeks of gestation and reported that LUS on D3–D4 and D7 accurately predicted BPD (according to Jensen et al [ 19 ]). However, lung ultrasonography performed within the first week of life has little value for GA-based models [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Extremely preterm infants born before 28 weeks of gestation benefit the most from accurate early prediction of BPD; however, recent studies have expressed concerns about the accuracy of LUSs for predicting BPD in this population. The evolution of LUSs in this population is significantly different from that in infants with gestational ages (GAs) of 28–30 weeks and 31–33 weeks, and a recent study found that the predictive value of LUSs may be insignificant in the multivariate models in which GA was the main predictor in this population [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of lung ultrasound scores with clinical models for predicting bronchopulmonary dysplasia

Dang

et al. 2023

Eur J Pediatr

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Lung ultrasound scores (LUSs) have been demonstrated to accurately predict moderate-to-severe bronchopulmonary dysplasia (msBPD). This study attempted to explore the additional value of LUSs for predicting msBPD compared to clinical multivariate models in different gestational age (GA) groups. The study prospectively recruited preterm infants with GA < 32 weeks. Lung ultrasound was performed on days 3, 7, 14, and 21 after birth. A linear mixed-effects regression model was used to evaluate LUS evolution in infants born before and after 28 weeks. The receiver operating characteristic (ROC) procedure was used to analyze the reliability of LUS and clinical multivariable models for predicting msBPD. The optimal time to predict msBPD in all infants was 7 days with a cut-off point of 5 (area under the ROC (AUROC) curve: 0.78, 95% confidence interval (CI): 0.71–0.84). In infants with GA ≥ 28 weeks, LUSs provided a moderate diagnostic accuracy for all four time points (AUROC curve: 0.74–0.78), and the AUROC curve for the clinical multivariable model on day 14 was 0.91 (95% CI: 0.84–0.96), which was significantly higher than that of LUSs (AUROC curve: 0.77, 95% CI: 0.68–0.85, P < 0.05). In infants born at 23–27 weeks, LUSs showed a low diagnostic accuracy with higher cut-off points to predict msBPD, and the AUROC curve for GA to predict msBPD was 0.75 (95% CI: 0.59–0.85), providing diagnostic accuracy similar to that of LUSs. Conclusion: The contribution of LUSs to predict msBPD in infants with different GAs remains controversial and requires further investigation. What is Known:• Lung ultrasound scores (LUSs) have been demonstrated to accurately predict moderate-to-severe bronchopulmonary dysplasia in infants with gestational age (GA)＜32 weeks. What is New:• The LUSs evolution differed between extremely preterm infants born before 28 weeks and preterm infants born at 28–32 weeks of gestation.• LUSs provided similar moderate predictive performance as GA-adjusted LUS and clinical multivariate models in infants born after 28 weeks, while LUSs seem to be less helpful in infants born before 28 weeks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of lung ultrasound scores with clinical models for predicting bronchopulmonary dysplasia

Dang

et al. 2023

Eur J Pediatr

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“…• LUS. Although some authors report that the use of LUS does not add to prediction of BPD development compared to models based on GA (73), a growing body of literature, detailed in Supplementary Table S3, is consistent in reporting the potential role of lung ultrasound, performed at different timing between the first 3 days of life up to 28 days in prediction of late BPD at 36 weeks PMA (28,(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). The predictivity of LUS towards development of BPD was also confirmed in a recent metaanalysis (84).…”

Section: Lung Ultrasound Markers For Bpd Association or Predictionmentioning

confidence: 99%

A scoping review of echocardiographic and lung ultrasound biomarkers of bronchopulmonary dysplasia in preterm infants

et al. 2023

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Despite recent improvements in neonatal care, moderate to severe bronchopulmonary dysplasia (BPD) is still associated with high mortality and with an increased risk of developing pulmonary hypertension (PH). This scoping review provides an updated overview of echocardiographic and lung ultrasound biomarkers associated with BPD and PH, and the parameters that may prognosticate their development and severity, which could be clinically helpful to undertake preventive strategies. A literature search for published clinical studies was conducted in PubMed using MeSH terms, free-text words, and their combinations obtained through appropriate Boolean operators. It was found that the echocardiography biomarkers for BPD, and especially those assessing right ventricular function, are reflective of the high pulmonary vascular resistance and PH, indicating a strong interplay between heart and lung pathophysiology; however, early assessment (e.g., during the first 1–2 weeks of life) may not successfully predict later BPD development. Lung ultrasound indicating poor lung aeration at day 7 after birth has been reported to be highly predictive of later development of BPD at 36 weeks' postmenstrual age. Evidence of PH in BPD infants increases risk of mortality and long-term PH; hence, routine PH surveillance in all at risk preterm infants at 36 weeks, including an echocardiographic assessment, may provide useful information. Progress has been made in identifying the echocardiographic parameters on day 7 and 14 to predict later development of pulmonary hypertension. More studies on sonographic markers, and especially on echocardiographic parameters, are needed for the validation of the currently proposed parameters and the timing of assessment before recommendations can be made for the routine clinical practice.

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“…The authors reported that in univariate analysis, lung USG scores on days 3-4 and day 7 accurately predicted BPD, however, in a multivariate model, the predictive value of lung USG was insignificant and gestational age was the dominant predictor. 27…”

Section: Bronchopulmonary Dysplasiamentioning

confidence: 99%

“…implemented a rigorous lung USG protocol in 100 infants <28 weeks gestation on day 1, day 3–4, day 7, day 28 and 36 weeks' postmenstrual age. The authors reported that in univariate analysis, lung USG scores on days 3–4 and day 7 accurately predicted BPD, however, in a multi‐variate model, the predictive value of lung USG was insignificant and gestational age was the dominant predictor 27 …”

Section: Lung Pathology and Relevant Studies In Neonatesmentioning

confidence: 99%

Lung ultrasound in neonates – An underused tool

Thakur

Fursule

2022

J Med Imag Rad Onc

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Point of care lung ultrasound (USG) can help in the diagnosis and management of critically sick neonates. It is based on seven simple principles that are comprehensive enough to diagnose all major lung pathologies. A compact small machine and a micro-convex or linear probe are the basic requirements to perform lung USG. In contrast to traditional USG principles, USG of the lung is based on artefacts. Some of the terminologies that are used to characterize normal lung include the pleural line, A-line, bat sign, lung sliding and seashore sign. Air/fluid mixture in varying ratios helps in diagnosis of normal lung, pneumothorax, interstitial syndrome (transient tachypnoea of newborn, respiratory distress syndrome, bronchopulmonary dysplasia), lung consolidation and pleural effusion.

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Early lung ultrasound affords little to the prediction of bronchopulmonary dysplasia

Cited by 14 publications

References 18 publications

Comparison of lung ultrasound scores with clinical models for predicting bronchopulmonary dysplasia

Comparison of lung ultrasound scores with clinical models for predicting bronchopulmonary dysplasia

A scoping review of echocardiographic and lung ultrasound biomarkers of bronchopulmonary dysplasia in preterm infants

Lung ultrasound in neonates – An underused tool

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