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

Abstract

Lung ultrasound (LU) has in recent years increasingly been used as a point-of-care method. Initially, LU was used as a so-called descriptive diagnostic method for neonatal respiratory diseases. Instead, this review article focuses on the use of LU as a "functional" tool using classification of findings in patterns or using semiquantitative scores. We review and describe the evidence that led to the implementation of LU in predicting the need for surfactant replacement therapy in preterm infants and in the identification of newborns at risk of developing bronchopulmonary dysplasia. LU appears to be a very promising method for the future of clinical management of newborns in both acute and chronic phases of pulmonary pathologies related to prematurity. However, further studies are needed to define its role before full implementation.

Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study

“…We assessed three chest areas on each side (upper anterior, lower anterior, and lateral) as described by Brat et al 22 Essentially, Brat et al scoring system categorizes the ultrasonographic lung findings into 4 patterns (pattern 1 [score 0]: A‐line pattern; pattern 2 [score 1]: ≥3 noncoalescent B‐lines; Pattern 3 (score 2): coalescent B‐line without or with consolidation limited to the subpleural space; pattern 4 [score 3]: extended consolidation). Subsequently, different scores were published 23 . Some studies included more lung zones those are, 8 zones, 10 zones, 12 zones, or even more than 12 zones.…”

“…Hence, researchers have created scores which inversely reflecting lung aeration. 21 We assessed three chest areas on each side (upper anterior, lower anterior, and lateral) as described by Brat et al 22 23 Some studies included more lung zones those are, 8 zones, 10 zones, 12 zones, or even more than 12 zones. On the other hand, several studies 24,25 have categorized lung ultrasound findings to more than 4 patterns compared to "original/standard" one published by Brat et.…”

Lung ultrasound in Italian neonatal intensive care units: A national survey

“…LU as a functional tool is a recent breakthrough and our data shows how NICUs are gradually adopting this method in clinical practice for the assessment of neonates with respiratory distress syndrome to predict surfactant need 32 . The score introduced by Brat et al in 2015 13 has opened a new functional approach in the use of LU and it is currently used by the majority of centers.…”

“…LU as a functional tool is a recent breakthrough and our data shows how NICUs are gradually adopting this method in clinical practice for the assessment of neonates with respiratory distress syndrome to predict surfactant need. 32 The score introduced by Brat The data of this survey, although they reflect a national reality, can be extremely useful for other nations who want to implement the method and could be the basis for an international survey and future international training program.…”

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

“…To systemically evaluate the whole lung, chest is divided into several zones. Based on the type of ultrasound findings identified, a score is assigned to each area, whose sum provides an overall score, known as LUS (31). The most used scores are those proposed by Brat et al ( 25) and 10D).…”