Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants

Abstract

Background Lung ultrasound (LU) has been widely used to diagnose and monitor acute lung diseases in neonates, but its role in chronic diseases has not been elucidated. Objective We aim to describe the evolution of a lung ultrasound score (LU score) in very low birth weight infants (VLBWI) with and without bronchopulmonary dysplasia (BPD). Methods We prospectively included 59 VLBWI and performed LU in the first 24 and 72 hours of life, and then weekly until 36 weeks´ postmenstrual age (PMA). We calculated the LU score as a semiquantitative score representing the aeration (0‐3) in three different areas of each lung. Results The non‐BPD group (n = 38) had lower LU score at 1, 2, 3, 4, and 36 weeks' PMA than the BPD group: median score of 1 (0‐4) vs 7 (3‐10), P < .001; 0 (0‐1) vs 7 (4‐9), P < .001; 0 (0‐1) vs 8 (7‐11), P < .001; 0 (0‐2) vs 9 (4‐12), P < .001; 0 (0‐0) vs 3 (0‐6), P < .001. A LU score of 5 or above at 1 week of life predicted BPD with a sensitivity (Se) of 71%, specificity (Sp) 80%, area under the ROC curve (AUC) 0.8, and at 2 weeks of life with Se 74%, Sp 100%, and AUC 0.93. An LU score of 4 or above at 4 weeks predicted moderate‐severe BPD (Se 100%, Sp 80%, and AUC 0.89). Conclusion In VLBWI without BPD, LU score increases during the first week of life and decreases thereafter, whereas among subjects with BPD, the LU score remains high until 36 weeks´ PMA. LU score can predict the diagnosis of BPD at 1 week and 2 weeks of life, and may predict moderate‐severe BPD at 4 weeks of life.

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

“…As we previously demonstrated, 10 BPD patients have higher LU scores than non‐BPD patients, and they remain high until 36 weeks' PMA, while non‐BPD patients experience a decrease in LU score from the very first week of life and it remains close to zero.…”

“…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 .…”

“…LU score is a real‐time indicator of extravascular lung water 16 and it also correlates with lung inflammation in preterm neonates 17 . On the other hand, LU scores remain high from birth until a postmenstrual age (PMA) of 36 weeks in very low birth weight infants with BPD 10 …”

Using lung ultrasound to quantitatively evaluate pulmonary water content

“…LUS scoring systems have been developed to meet the need for standardization and have been shown to correlate with various metrics in adults and neonates . These scoring systems are used to assess the severity, course, and prognosis of the disease and then guide the treatment . Nevertheless, it remains unclear about the degree of lung water content that can cause pulmonary dysfunction, and how to quantitatively assess lung water content by ultrasound.…”

“…[10][11][12][13] These scoring systems are used to assess the severity, course, and prognosis of the disease and then guide the treatment. [14][15][16][17] Nevertheless, it remains unclear about the degree of lung water content that can cause pulmonary dysfunction, and how to quantitatively assess lung water content by ultrasound. And the correlation between B-line score (BLS) and the EVLW content is still not clear.…”