Prognostic Relevance of the Lung Ultrasound Score: A Multioutcome Study in Infants with Respiratory Distress Syndrome

Abstract

Objective There is growing evidence for the usefulness of the lung ultrasound score (LUS) in neonatal intensive care. We evaluated whether the LUS is predictive of outcomes in infants with respiratory distress syndrome (RDS). Study Design Neonates less than 34 weeks of gestational age were eligible for this prospective, multicenter cohort study. The outcomes of interest were the need for mechanical ventilation (MV) at <72 hours of life, the need for surfactant (SF), successful weaning from continuous positive airway pressure (CPAP), extubation readiness, and bronchopulmonary dysplasia. Lung scans were taken at 0 to 6 hours of life (Day 1), on Days 2, 3, and 7, and before CPAP withdrawal or extubation. Sonograms were scored (range 0–16) by a blinded expert sonographer. The area under the receiver operating characteristic curve (AUC) was used to estimate the prediction accuracy of the LUS. Results A total of 647 scans were obtained from 155 newborns with a median gestational age of 32 weeks. On Day 1, a cutoff LUS of 6 had a sensitivity (Se) of 88% and a specificity (Sp) of 79% to predict the need for SF (AUC = 0.86), while a cutoff LUS of 7 predicted the need for MV at <72 hours of life (Se = 89%, Sp = 65%, AUC = 0.80). LUS acquired prior to weaning off CPAP was an excellent predictor of successful CPAP withdrawal, with a cutoff level of 1 (Se = 67%, Sp = 100%, AUC = 0.86). Conclusion The LUS has significant predictive ability for important outcomes in neonatal RDS. Key Points

Diagnostic Accuracy of Lung Ultrasound in Neonatal Diseases: A Systematized Review

“…A prospective, multicenter cohort study was performed by Szymański et al [ 21 ] to assess the ability of LUS to predict important outcomes among neonates with RDS. This study included 155 neonates from five centers and evaluated outcomes such as the need for MV at <72 h of life, the need for surfactant administration, successful weaning from NCPAP, extubation readiness, and the development of moderate to severe BPD.…”

“…Similarly, the utility of LUS in predicting MV and surfactant need among infants with RDS has been confirmed by a meta-analysis [ 10 ] and other studies, which mostly included infants with specific gestational age intervals [ 10 , 15 , 17 , 18 , 19 ]. Newer, interesting applications of LUS among infants with RDS that need further confirmation studies include lung recruitment guidance [ 20 ], outcome prediction [ 21 ], and monitoring of respiratory status [ 22 ]. Indeed, these studies were small or did not report all relevant outcomes.…”

Descriptive and Functional Genomics in Neonatal Respiratory Distress Syndrome: From Lung Development to Targeted Therapies

“…Furthermore, increasing evidence supports the utility of the lung ultrasound score (LUS) in neonatal intensive care, having a significant predictive capacity for important outcomes in neonatal RDS [ 157 ]. For preterm neonates with RDS, the trajectory of the LUS is influenced by gestational age, strongly linked with oxygenation status, and serves as a predictive indicator for bronchopulmonary dysplasia [ 158 ].…”