Evolution of Ultrasound-Assessed Lung Aeration and Gas Exchange in Respiratory Distress Syndrome and Transient Tachypnea of the Neonate

Lucilla Pezza; Victor Sartorius; Barbara Loi; Giulia Regiroli; Roberta Centorrino; Lucia Lanciotti; Virgilio P Carnielli; Daniele De Luca

doi:10.1016/j.jpeds.2022.11.037

Evolution of Ultrasound-Assessed Lung Aeration and Gas Exchange in Respiratory Distress Syndrome and Transient Tachypnea of the Neonate

J Pediatr. 2023 May:256:44-52.e2. doi: 10.1016/j.jpeds.2022.11.037. Epub 2022 Dec 6.

Authors

Lucilla Pezza¹, Victor Sartorius¹, Barbara Loi¹, Giulia Regiroli¹, Roberta Centorrino¹, Lucia Lanciotti², Virgilio P Carnielli², Daniele De Luca³

Affiliations

¹ Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France.
² Division of Neonatology, "G. Salesi" Women and Children's Hospital, Polytechnical University of Marche, Ancona, Italy.
³ Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris-Saclay University, Paris, France.

PMID: 36493883
DOI: 10.1016/j.jpeds.2022.11.037

Abstract

Objective: To use clinical, lung ultrasound, and gas exchange data to clarify the evolution of lung aeration and function in neonates with respiratory distress syndrome (RDS) and transient tachypnea of the neonate (TTN), the most common types of neonatal respiratory failure.

Study design: In this prospective observational cohort study, lung aeration and function were measured with a semiquantitative lung ultrasound score (LUS) and transcutaneous blood gas measurement performed at 1 hour (time point 0), 6 hours (time point 1), 12 hours (time point 2), 24 hours (time point 3) and 72 hours (time point 4) of life. Endogenous surfactant was estimated using lamellar body count (LBC). LUS, oxygenation index (OI), oxygen saturation index (OSI), and transcutaneous pressure of carbon dioxide (PtcCO₂) were the primary outcomes. All results were adjusted for gestational age.

Results: Sixty-nine neonates were enrolled in the RDS cohort, and 58 neonates were enrolled in the TTN cohort. LUS improved over time (within-subjects, P < .001) but was worse for the RDS cohort than for the TTN cohort at all time points (between-subjects, P < .001). Oxygenation improved over time (within-subjects, P = .011 for OI, P < .001 for OSI) but was worse for the RDS cohort than for the TTN cohort at all time points (between-subjects, P < .001 for OI and OSI). PtcCO₂ improved over time (within-subjects, P < .001) and was similar in the RDS and TTN cohorts at all time points. Results were unchanged after adjustment for gestational age. LBC was associated with RDS (β = -0.2 [95% CI, -0.004 to -0.0001]; P = .037) and LUS (β = -3 [95% CI, -5.5 to -0.5]; P = .019).

Conclusions: For the first 72 hours of life, the RDS cohort had worse lung aeration and oxygenation compared with the TTN cohort at all time points. CO₂ clearance did not differ between the cohorts, whereas both lung aeration and function improved in the first 72 hours of life.

Keywords: lung ultrasonography; newborn infant; respiratory distress syndrome; respiratory failure; transient tachypnea of the neonate.

Publication types

Observational Study

MeSH terms

Cohort Studies
Humans
Infant, Newborn
Lung / diagnostic imaging
Lung / physiology
Prospective Studies
Respiratory Distress Syndrome, Newborn* / diagnosis
Respiratory Distress Syndrome, Newborn* / diagnostic imaging
Tachypnea
Transient Tachypnea of the Newborn* / diagnostic imaging
Ultrasonography