Lung Ultrasound Scores Progress Differently in Extreme and Very Preterm Infants after Birth: A Multicentre Prospective Study

Abstract

<b><i>Introduction:</i></b> The lung ultrasound score (LUS) has been suggested to predict moderate-severe bronchopulmonary dysplasia (msBPD) in preterm infants. We aimed to assess LUS evolution after birth in preterm infants and the effect of gestational age. <b><i>Methods:</i></b> This multicentre prospective observational study was performed with newborns born before 33 weeks of gestation. We created two groups: group 1 (23–27 weeks) and group 2 (28–32 weeks). We compared LUSs between the groups from birth until 36 weeks of postmenstrual age, and we estimated the LUS evolution in each group with a linear multilevel mixed-effects regression model. The effects of the need for surfactant or an msBPD diagnosis were also studied. <b><i>Results:</i></b> We included 339 patients: 122 (36%) in group 1 and 217 (64%) in group 2. The infants in group 1 showed a steady progression in the LUS from birth until 4 weeks of age and a subsequent decrease; the infants in group 2 showed a progressive decrease in the LUS throughout the study. This progression varied significantly in the first weeks of life in infants who required surfactant at birth and after the first week of life in the patients diagnosed with msBPD. <b><i>Discussion/Conclusions:</i></b> Extremely preterm infants showed persistently high LUSs during the first weeks of life, regardless of the progression to msBPD. In this group, the infants who did not require surfactant at birth exhibited an increase in their LUSs after the first week until their values were equal to the remaining infants in their group.

Comparison of lung ultrasound scores with clinical models for predicting bronchopulmonary dysplasia

“…In infants born at 28–32 weeks of gestation, LUSs performed well in predicting the development of msBPD, similar to that observed in the total sample. LUSs decreased rapidly during the first week of life and remained high and stable in infants with evolving msBPD, as previously reported [ 12 , 21 ]. Interestingly, the present study found that the predictive performance of the clinical five-factor model was superior to that of LUSs on D14.…”

“…Alonso-Ojembarrena et al [ 12 ] and Raimondi et al [ 21 ] reported different LUS patterns from birth until 6–14 weeks in infants born before 28 weeks. Persistently high LUSs in the first 4 weeks after birth for infants with GA < 28 weeks were described, regardless of their subsequent evolution to msBPD.…”

“…Extremely preterm infants born before 28 weeks of gestation benefit the most from accurate early prediction of BPD; however, recent studies have expressed concerns about the accuracy of LUSs for predicting BPD in this population. The evolution of LUSs in this population is significantly different from that in infants with gestational ages (GAs) of 28–30 weeks and 31–33 weeks, and a recent study found that the predictive value of LUSs may be insignificant in the multivariate models in which GA was the main predictor in this population [ 11 , 12 ].…”

Accuracy of lung ultrasound in predicting extubation failure in neonates: A systematic review and meta‐analysis

“…5 Extremely preterm infants and very low birth weight infants had persistently high LUS during the first few weeks of life regardless to duration of IMV or development of bronchopulmonary dysplasia. 41,42 High LUS can be explained by pulmonary insufficiency of prematurity. To further investigate, we performed a subgroup analysis to identify LUS diagnostic accuracy in extremely preterm and very low birth weight infants.…”

“…Previous data indicate that extremely preterm infants are at a higher risk of requiring IMV and experiencing extubation failure, potentially due to lung immaturity 5 . Extremely preterm infants and very low birth weight infants had persistently high LUS during the first few weeks of life regardless to duration of IMV or development of bronchopulmonary dysplasia 41,42 . High LUS can be explained by pulmonary insufficiency of prematurity.…”