Lung ultrasound assessment of pulmonary edema in neonates with chronic lung disease before and after diuretic therapy

Abstract

Introduction: Bronchopulmonary dysplasia (BPD) is characterized by lung injury with varying degrees of disrupted alveolarization, vascular remodeling, inflammatory cell proliferation, and pulmonary edema. Diuretics are often used to ameliorate the symptoms or progression of BPD. Our primary objective was to use lung ultrasound (LUS) to determine if diuretics decrease pulmonary edema in infants with BPD. The secondary objective was to assess changes in respiratory support during the first week after initiation of diuretics.Methods: Premature infants requiring noninvasive respiratory support and starting diuretic therapy for evolving BPD were compared with a similar group of infants not receiving diuretics (control). For the diuretic group, LUS exams were performed before and on Days 1, 3, and 6 after initiation of treatment. For the control group, LUS was performed at equivalent time points. A composite pulmonary edema severity (PES) score of 0-5 was calculated based on the total number of B-lines in six scanned areas. Respiratory support parameters (FiO 2 , nasal cannula flow, or CPAP) were also recorded.Results: Infants in the diuretic (n = 28) and control (n = 23) groups were recruited at median corrected gestational ages of 34.2 (33.3-35.9) and 34.0 (33.4-36.3) weeks, respectively (p = 0.82). PES scores, FiO 2 , and respiratory flow support decreased significantly from Days 0 to 6 (p < 0.0001, p = 0.001, and p = 0.01, respectively) in the diuretic group, but not in the control group. Conclusion:Diuretic use is associated with decreased pulmonary edema and improved oxygenation in infants with BPD during the first week of treatment.

The Role of Point of Care Lung Ultrasound in Diagnosis of Different Neonatal Lung Diseases in NICU: A Prospective Study

“…In this study US showed Sn and Sp for diagnosis of pulmonary edema of 100% for both with total agreement of 100% with X-ray. This is in agreement with Kasniya et al (16) who showed the similar results.…”

“…As regard pulmonary edema features by ultrasound, the current study showed that the main features were presence compact B lines without consolidation and normal pleural line in 100% of cases. This is in accordance with Kasniya et al (16) who studied 51 infants with evolving CLD on invasive O2 therapy and revealed that the number of B lines has been closely connected with the severity of pulmonary edema, and that utilising LUS by the detection of "B lines diagnose neonates with pulmonary edema has been demonstrated to be more sensitive and with greater NPV than X-rays. "…”

Targeted neonatal echocardiography and lung ultrasound in preterm infants with chronic lung disease with and without pulmonary hypertension, screened using a standardized algorithm

“…In the present study, we found a decrease in pulmonary edema after diuretic treatment. Recently, a case–control study using a modified score also showed that diuretic use is associated with decreased pulmonary edema and improved oxygenation in infants with CLD during the first week of treatment ( 29 ). Further prospective research needs to be conducted to explore LUS score progression after diuretic treatment as a suitable biomarker of CLD development and progression.…”

2022 Year in review: Neonatal pulmonology

“…These differences were associated with an improvement in oxygenation, respiratory rate, and CO 2 . Kasniya et al, 6 the single contribution from the USA, from Cohen Children's Hospital, gave us a nice example of “B‐lines” in preterm infants born at 24–30 weeks GA, who were on CPAP or nasal canula for evolving BPD. These infants were divided into a control group (no diuretics) and diuretic group.…”