Early lung ultrasound score to predict noninvasive ventilation needing in neonates from 33 weeks of gestational age: A multicentric study

Abstract

Objective To propose an early lung ultrasound (LUS) score for the prediction of the need for respiratory assistance in newborns of gestational age (GA) ≥ 33 weeks presenting respiratory distress. Study Design and Setting Multicenter, prospective observational study in third‐level neonatal intensive care units. Patient Selection Infants with GA ≥ 33 + 0 weeks with respiratory distress within 3 h of life. Methods Three LUS for each patient were collected: within 3 h of life (T0), at 4–6 h of life (T1), and at the resolution of symptoms (T2). The primary aim was to assess the validity of the early LUS score in predicting the need for continuous positive airway pressure (CPAP). We also evaluated the validity of the score in predicting the need for surfactant, the scores' trend in our population, and any correlation with the duration of ventilation and oxygen therapy. Results Sixty‐two patients were enrolled in the study. The mean GA was 36 weeks. The receiver operating characteristic analysis for the LUS T0 and T1 yielded area under the curves of 0.91 and 0.82 in predicting the need for CPAP, respectively. LUS score cut off of 6 (sensitivity 84.8%, specificity 86.2%) and 5 (sensitivity 66.7%, specificity 100%) were calculated at T0 and T1, respectively. We found significant correlations between LUS score and respiratory assistance, surfactant administration, and SpO2/FiO2 ratio. Conclusion An early LUS score is a good noninvasive predictor of the need for respiratory assistance with CPAP and surfactant administration in newborns with GA ≥ 33 weeks.

Optimal timing and cutoff range of lung ultrasound in predicting surfactant administration in neonates: A meta-analysis and systematic review

“…After reading the titles, abstracts and full texts of the 518 related articles, a total of 10 eligible studies with 1162 participants were included. [ 9 , 15 , 17 – 20 , 22 – 24 , 26 ] The flow diagram for study selection is shown in Fig 1 . Some of the studies that were excluded for varying reasons are summarized in S1 Table .…”

“…The other 3 articles [ 15 , 18 , 24 ] did not clearly state which guidelines were used for designing the standards for surfactant use but still highlighted the need to focus on ventilator parameters such as FiO2 and SpO2. With regards to the diagnostic criteria for lung ultrasound, 9 articles [ 9 , 15 , 17 , 18 , 20 , 22 – 24 , 26 ] employed the 3-region 18-point scoring system established by Brat et al [ 9 ] in evaluating the lung ultrasound results. One article [ 19 ] performed qualitative evaluation by classifying lung ultrasound images into different types based on A-line and B-line distribution [ 11 ] but did not provide the diagnostic data.…”

“…One article [ 19 ] performed qualitative evaluation by classifying lung ultrasound images into different types based on A-line and B-line distribution [ 11 ] but did not provide the diagnostic data. For study type, 9 of the 10 studies were cohort studies [ 9 , 15 , 17 – 20 , 22 , 23 , 26 ]. Among these studies, those conducted by Brat et al [ 9 ] and Perri et al [ 22 ] set multiple LUS cutoffs based on gestational age or timing of lung ultrasound and obtained the corresponding diagnostic results.…”

2022 Year in review: Neonatal pulmonology

“…Perri et al 7 reported a study using a previously described LUS from Brat et al 9 and a descriptive score of the predominant LU pattern 10 (and both of these papers have good examples for beginning learners) to examine the need for noninvasive respiratory support (primarily continuous positive airway pressure (CPAP) and surfactant use. Using the Brat score, each lung is divided into three regions and assigned a score of 0–3.…”

Application of ultrasonography in neonatal lung disease: An updated review

“…LUS scores obtained during the first days of life can provide information about the prognosis of neonatal respiratory failure ( 154 ) and predict the need for respiratory support ( 155 – 157 ). In addition, LUS performs a useful role in predicting non-invasive ventilation failure in neonates with respiratory distress, and this is important for the clinician to decide to apply invasive mechanical ventilation to prevent clinical deterioration ( 154 , 158 – 160 ).…”