Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction

De Luca, Daniele; Loi, Barbara; Tingay, David; Fiori, Humberto; Kingma, Paul; Dellacà, Raffaele; Autilio, Chiara

doi:10.1016/j.siny.2023.101494

Cited by 4 publications

(5 citation statements)

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“…However, there is no consensus on a gold standard to identify surfactant deficiency or dysfunction at the bedside, and the FiO 2 is the most widely used criterion; thus, our results are pragmatically useful. 8 The studied sample size may seem relatively small but was comparable to that of previous studies recruiting preterm neonates 3 , 12 and respected the targeted sample size calculation. We included neonates who already had signs of respiratory failure (ie, high suspicion index); thus, our data cannot support LUS to be used as a pure screening test in asymptomatic neonates.…”

Section: Discussionsupporting

confidence: 60%

“…Surfactant treatment in this population represents an open clinical problem since patients may be affected by different types of respiratory failure with variable surfactant deficiency or dysfunction, and these are difficult to assess at the bedside. 8 Clinical, biologic, or imaging tests available to date have been either cumbersome or inaccurate, leaving surfactant treatment unguided. 8 Quantitative lung ultrasonography is known to describe the lung volume available for gas exchange (ie, lung aeration) and has been validated against a number of techniques.…”

Section: Discussionmentioning

confidence: 99%

“… 8 Clinical, biologic, or imaging tests available to date have been either cumbersome or inaccurate, leaving surfactant treatment unguided. 8 Quantitative lung ultrasonography is known to describe the lung volume available for gas exchange (ie, lung aeration) and has been validated against a number of techniques. 2 , 31 In particular, lung aeration is correlated with surfactant adsorption early after birth, 32 , 33 and this makes LUS pathobiologically sound to detect surfactant deficiency or dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Using FiO 2 thresholds is, however, an oversimplified method since inspired oxygen is only one of the many factors influencing oxygenation. 7 Moreover, oxygenation impairment is the last consequence in the pathophysiology cascade of events 8 ; thus, FiO 2 can increase after the optimal time window for surfactant administration (ie, the first 2-3 hours of life). 9 Despite these drawbacks, FiO 2 thresholds are still widely used to decide whether to administer surfactant.…”

Section: Introductionmentioning

confidence: 99%

“…neonates. An LUS higher than8 was associated with the highest global accuracy (replacement test), suggesting it can be used to guide surfactant administration. Neonatal LUS values of 4 or lower were associated with the highest sensitivity (triage test), suggesting an unlikely need for surfactant in this population.…”

mentioning

confidence: 99%

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Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later

De Luca,

Bonadies,

Alonso-Ojembarrena

et al. 2024

JAMA Netw Open

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ImportanceSurfactant administration may be needed in late preterm through full-term neonates, but the pathophysiology of their respiratory failure can be different from that of early preterm neonates. The lung ultrasonography score (LUS) is accurate to guide surfactant replacement in early preterm neonates, but to our knowledge, it has not yet been studied in the late preterm through full-term neonatal population.ObjectiveTo assess whether LUS is equally accurate to predict surfactant need in late preterm through full-term neonates as in early preterm neonates.Design, Setting, and ParticipantsThis prospective, international, multicenter diagnostic study was performed between December 2022 and November 2023 in tertiary academic neonatal intensive care units in France, Italy, Spain, and the US. Late preterm through full-term neonates (≥34 weeks’ gestation) with respiratory failure early after birth were enrolled.ExposurePoint-of-care lung ultrasonography to calculate the neonatal LUS (range, 0-18, with higher scores indicating worse aeration), which was registered in dedicated research databases and unavailable for clinical decision-making.Main Outcomes and MeasuresThe main outcomes were the area under the curve (AUC) in receiver operating characteristic analysis and derived accuracy variables, considering LUS as a replacement for other tests (ie, highest global accuracy) and as a triage test (ie, highest sensitivity). Sample size was calculated to assess noninferiority of LUS to predict surfactant need in the study population compared with neonates born more prematurely. Correlations of LUS with the ratio of hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) to fraction of inspired oxygen (FiO2) and with the oxygen saturation index (OSI) were assessed.ResultsA total of 157 neonates (96 [61.1%] male) were enrolled and underwent lung ultrasonography at a median of 3 hours (IQR, 2-7 hours) of life; 32 (20.4%) needed surfactant administration (pretest probability, 20%). The AUC was 0.87 (95% CI, 0.81-0.92). The highest global accuracy and sensitivity were reached for LUS values higher than 8 or 4 or lower, respectively. Subgroup analysis gave similar diagnostic accuracy in neonates born late preterm (AUC, 0.89; 95% CI, 0.81-0.97; n = 111) and early term and later (AUC, 0.84; 95% CI, 0.73-0.96; n = 46). After adjusting for gestational age, LUS was significantly correlated with SpO2:FiO2 (adjusted β, −10.4; 95% CI, −14.0 to −6.7; P &lt; .001) and OSI (adjusted β, 0.2; 95% CI, 0.1-0.3; P &lt; .001).Conclusions and RelevanceIn this diagnostic study of late preterm through full-term neonates with respiratory failure early after birth, LUS accuracy to predict surfactant need was not inferior to that observed in earlier preterm neonates. An LUS higher than 8 was associated with highest global accuracy (replacement test), suggesting that it can be used to guide surfactant administration. An LUS value of 4 or lower was associated with the highest sensitivity (triage test), suggesting it is unlikely for this population to need surfactant.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%