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

Piotr Szymański; Joanna Puskarz-Gąsowska; Roman Hożejowski; Małgorzata Stefańska; Witold Błaż; Iwona Sadowska-Krawczenko; Urszula Majewska; Anna Tomaszkiewicz; Małgorzata Piotrowska; Marta Kusibab-Mytych; Natalia Słowik-Wasyluk; Piotr Kruczek; Renata Bokiniec

doi:10.1055/s-0043-1775975

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

Am J Perinatol. 2023 Oct 17. doi: 10.1055/s-0043-1775975. Online ahead of print.

Authors

Piotr Szymański^{1

2}, Joanna Puskarz-Gąsowska³, Roman Hożejowski⁴, Małgorzata Stefańska⁵, Witold Błaż^{6

7}, Iwona Sadowska-Krawczenko⁸, Urszula Majewska³, Anna Tomaszkiewicz^{1

6}, Małgorzata Piotrowska⁸, Marta Kusibab-Mytych⁵, Natalia Słowik-Wasyluk⁶, Piotr Kruczek^{1

2}, Renata Bokiniec³

Affiliations

¹ Department of Neonatology, Ujastek Medical Center, Cracow, Poland.
² Department of Neonatology, Czerwiakowski Hospital at Siemiradzki St., Cracow, Poland.
³ Department of Neonatal and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
⁴ Medical Department, Chiesi Poland, Warsaw, Poland.
⁵ Department of Neonatal and Intensive Care, F. Chopin District Specialist Hospital, Rzeszów, Poland.
⁶ Department of Neonatal and Intensive Care, Rzeszów Provincial Hospital No. 2, Rzeszów, Poland.
⁷ Faculty of Medicine, University of Rzeszów, Rzeszów, Poland.
⁸ Department of Neonatology, Jan Biziel University Hospital No. 2, Bydgoszcz, Poland.

PMID: 37848043
DOI: 10.1055/s-0043-1775975

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: · Lung ultrasound has significant prognostic abilities in neonatal RDS.. · Early sonograms (0-6 h of life) accurately predict the requirement for SF and ventilation.. · Weaning off CPAP is effective when the LUS (range 0-16) is less than or equal to 1..

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).