Estimating Preterm Lung Volume: A Comparison of Lung Ultrasound, Chest Radiography, and Oxygenation

Arun Sett; Sheryle R Rogerson; Gillian W C Foo; Jacqui Keene; Niranjan Thomas; Penny P L Kee; Amir Zayegh; Susan M Donath; David G Tingay; Peter G Davis; Brett J Manley

doi:10.1016/j.jpeds.2023.113437

Estimating Preterm Lung Volume: A Comparison of Lung Ultrasound, Chest Radiography, and Oxygenation

J Pediatr. 2023 Aug:259:113437. doi: 10.1016/j.jpeds.2023.113437. Epub 2023 Apr 22.

Authors

Arun Sett¹, Sheryle R Rogerson², Gillian W C Foo³, Jacqui Keene⁴, Niranjan Thomas⁵, Penny P L Kee⁶, Amir Zayegh⁷, Susan M Donath⁸, David G Tingay⁹, Peter G Davis¹⁰, Brett J Manley¹⁰

Affiliations

¹ Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia. Electronic address: Arun.Sett@thewomens.org.au.
² Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia.
³ Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia.
⁴ Department of Radiology, The Royal Women's Hospital, Melbourne, Australia.
⁵ Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.
⁶ Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Australia; Paediatric Infant Perinatal Emergency Retrieval, The Royal Children's Hospital, Melbourne, Australia.
⁷ Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.
⁸ Murdoch Children's Research Institute, Victoria, Australia.
⁹ Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of Neonatology, Royal Children's Hospital, Melbourne, Australia.
¹⁰ Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia.

PMID: 37088185
DOI: 10.1016/j.jpeds.2023.113437

Abstract

Objective: To determine the relationship between lung ultrasound (LUS) examination, chest radiograph (CXR), and radiographic and clinical evaluations in the assessment of lung volume in preterm infants.

Study design: In this prospective cohort study LUS was performed before CXR on 70 preterm infants and graded using (1) a LUS score, (2) an atelectasis score, and (3) measurement of atelectasis depth. Radiographic diaphragm position and radio-opacification were used to determine global and regional radiographic atelectasis. The relationship between LUS, CXR, and oxygenation was assessed using receiver operator characteristic and correlation analysis.

Results: LUS scores, atelectasis scores, and atelectasis depth did not correspond with radiographic global atelectasis (area under receiver operator characteristics curves, 0.54 [95% CI, 0.36-0.71], 0.49 [95% CI, 0.34-0.64], and 0.47 [95% CI, 0.31-0.64], respectively). Radiographic atelectasis of the right upper, right lower, left upper, and left lower quadrants was predicted by LUS scores (0.75 [95% CI, 0.59-0.92], 0.75 [95% CI, 0.62-0.89], 0.69 [95% CI, 0.56-0.82], and 0.63 [95% CI, 0.508-0.751]) and atelectasis depth (0.66 [95% CI, 0.54-0.78], 0.65 [95% CI, 0.53-0.77], 0.63 [95% CI, 0.50-0.76], and 0.56 [95% CI, 0.44-0.70]). LUS findings were moderately correlated with oxygen saturation index (ρ = 0.52 [95% CI, 0.30-0.70]) and saturation to fraction of inspired oxygen ratio (ρ = -0.63 [95% CI, -0.76 to -0.46]). The correlation between radiographic diaphragm position, the oxygenation saturation index, and peripheral oxygen saturation to fraction of inspired oxygen ratio was very weak (ρ = 0.36 [95% CI, 0.11-0.59] and ρ = -0.32 [95% CI, -0.53 to -0.07], respectively).

Conclusions: LUS assessment of lung volume does not correspond with radiographic diaphragm position preterm infants. However, LUS predicted radiographic regional atelectasis and correlated with oxygenation. The relationship between radiographic diaphragm position and oxygenation was very weak. Although LUS may not replace all radiographic measures of lung volume, LUS more accurately reflects respiratory status in preterm infants.

Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12621001119886.

Keywords: chest radiograph; lung ultrasound; lung volume; neonate; ventilation.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Humans
Infant
Infant, Newborn
Infant, Premature*
Lung / diagnostic imaging
Lung Volume Measurements
Prospective Studies
Pulmonary Atelectasis* / diagnostic imaging
Radiography
Ultrasonography

Associated data

ANZCTR/ACTRN12621001119886