Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section

Abstract

We aimed to evaluate the reliability of lung ultrasound (LU) to predict admission to the neonatal intensive care unit (NICU) for transient neonatal tachypnoea or respiratory distress syndrome in infants born by caesarean section (CS). A prospective, observational, single-centre study was performed in the delivery room and NICU of Sant’Orsola-Malpighi Hospital in Bologna, Italy. Term and late-preterm infants born by CS were included. LU was performed at 30’ and 4 h after birth. LU appearance was graded according to a previously validated three-point scoring system (3P-LUS: type-1, white lung; type-2, black/white lung; type-3, normal lung). Full LUS was also calculated. One hundred infants were enrolled, and seven were admitted to the NICU. The 5 infants with bilateral type-1 lung at birth were all admitted to the NICU. Infants with type-2 and/or type-3 lung were unlikely to be admitted to the NICU. Mean full-LUS was 17 in infants admitted to the NICU, and 8 in infants not admitted. In two separate binary logistic regression models, both the 3P- and the full LUS proved to be independently associated with NICU admission (OR [95% CI] 0.001 [0.000–0.058], P = .001, and 2.890 [1.472–5.672], P = .002, respectively). The ROC analysis for the 3P-LUS yielded an AUC of 0.942 (95%CI, 0.876–0.979; P<.001), while ROC analysis for the full LUS yielded an AUC of 0.978 (95%CI, 0.926–0.997; P<.001). The AUCs for the two LU scores were not significantly different (p = .261). Conclusion: the 3P-LUS performed 30 min after birth proved to be a reliable tool to identify, among term and late preterm infants born to CS, those who will require NICU admission for transient neonatal tachypnoea or respiratory distress syndrome. What is known• Lung ultrasound (LU) has become an attractive diagnostic tool in neonatal settings, and guidelines on point-of-care LU in the neonatal intensive care unit (NICU) have been recently issued.• LU is currently used for diagnosing several neonatal respiratory morbidities and has been also proposed for predicting further intervention, such as NICU admission, need for surfactant treatment or mechanical ventilation in preterm infants. What is new• LU performed 30′ after birth and evaluated through a simple three-point scoring system represents a reliable tool to identify, among term and late preterm infants born to caesarean section, those with transient neonatal tachypnoea or respiratory distress syndrome who will require NICU admission.• LU performed in the neonatal period confirms its potential role in ameliorating routine neonatal clinical management.

Lung ultrasound scores in neonatal clinical practice: A narrative review of the literature

“…The same patterns classification has recently been used to predict the need for NICU admission in infants born by caesarean section (CS) with transient tachypnea of the newborn (TTN) or RDS 13 . Poerio et al studied full‐term or late‐preterm infants born by CS.…”

“…12 The same patterns classification has recently been used to predict the need for NICU admission in infants born by caesarean section (CS) with transient tachypnea of the newborn (TTN) or RDS. 13 Poerio et al studied full-term or late-preterm infants born by CS. Admission to the NICU was based on occurrence in the delivery room of clinical signs of respiratory distress which did not resolve within 60 min of life.…”

Lung ultrasound is used in neonatology for diagnostics, monitoring and prognostics, but also for prevention

“…4,5 In parallel, with its high power in differentiating between respiratory distress syndrome and transient tachypnea of the newborn, LU could help to reduce unnecessary intensive care admissions and treatments. 6 The diagnostic power of LU is also supported by strong evidence of its value in adult populations, in cases of pneumothorax, atelectasis, or pleural effusion, for instance. These diseases may also occur in premature neonates, and could be promptly, easily, and reliably diagnosed with LU, in a radiation-free approach.…”

“…In parallel, with its high power in differentiating between respiratory distress syndrome and transient tachypnea of the newborn, LU could help to reduce unnecessary intensive care admissions and treatments 6 …”

Utility of lung ultrasound and respiratory severity score for detection of respiratory distress syndrome in the delivery room

“…Helpfully, we are starting to see reports on the performance of very early point-of-care lung ultrasound in the delivery room. 3 One consideration to leverage both of these modalities to synergistically improve the identification of patients who would benefit from surfactant, for example, would be a two-stage process involving the use of the RSS in the delivery room to select premature infants who could then receive lung ultrasound for confirmation. Would this perhaps improve diagnostic performance over either as a singular test?…”