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Loganathan PK, Meau-Petit V, Bhojnagarwala B, Nair V, Holmes J, Occhipinti A, Montasser M. Serial lung ultrasound in predicting the need for surfactant and respiratory course in preterm infants-multicentre observational study (SLURP). Eur J Pediatr 2025; 184:356. [PMID: 40407825 PMCID: PMC12102118 DOI: 10.1007/s00431-025-06185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 05/06/2025] [Accepted: 05/12/2025] [Indexed: 05/26/2025]
Abstract
Lung ultrasound (LUS) scores may predict surfactant need early and the progression of the respiratory course in preterm infants. The objective of this study is to report the diagnostic value of LUS scores performed by operators of varying levels of experience to predict the need for surfactant in preterm infants. A prospective observational study was conducted across 3 UK-based neonatal intensive care units. Preterm infants ≤ 34 weeks on non-invasive respiratory support within 3 h of birth were included. Ten lung zones were scored serially, first within the first 3 h of life, then at 12-24-h intervals (a total of four scans). All scans were performed by the local team members with formal training on LUS and varying levels of expertise. All the LUS videos were scored by an expert investigator who was blinded to clinical details. Written retrospective parental consents were obtained. We recruited 83 preterm infants ≤ 34 weeks (May 2023 to June 2024). A total of 325 LUS scans were performed by 27 clinical staff. The median birth gestational age and birth weight were 31 weeks and 1515 g, respectively. Twenty-eight (34%) babies received surfactants. The first LUS using a 6-zone method within 3 h of life predicted surfactant need and bronchopulmonary dysplasia with an AUC of 0.80 for both outcomes, offering sensitivity (79% and 73%) and specificity (75% and 76%), respectively. CONCLUSIONS LUS performed by operators of varying levels of experience within the first 3 h of life is a reliable tool for predicting surfactant need in preterm infants ≤ 34 weeks. TRIAL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov/ ): NCT05782569. WHAT IS KNOWN • There are considerable variations in the selection criteria of preterm infants for surfactant administration. • Lung ultrasound score has been shown to predict the need for surfactant early and the progression of respiratory course in preterm infants. WHAT IS NEW • LUS performed within 3 h of life by operators of varying levels of experience and interpreted by expert predicted the need for surfactant deficiency in preterm infants. • Our research with a structured training programme enabled novice operators to perform LUS and achieve reasonable competency.
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Affiliation(s)
- P K Loganathan
- Neonatal Unit, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
- Clinical Academic Office, Faculty of Medical Sciences, Newcastle University, Newcastle, UK.
- University of Durham, Durham, DH1 3LE, UK.
| | - V Meau-Petit
- Neonatal and Paediatric Intensive Care Unit, Franco-Britannique Hospital, Levallois-Perret, France
| | - B Bhojnagarwala
- Oliver Fisher Neonatal Unit, Medway NHS Foundation Trust, Kent, UK
| | - V Nair
- Neonatal Unit, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - J Holmes
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, UK
| | - A Occhipinti
- School of Computing, Engineering and Digital Technologies, Teesside University, Middlesbrough, UK
| | - M Montasser
- Neonatal Unit, University Hospital Wishaw, Scotland, UK
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2
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Mongodi S, Cortegiani A, Alonso-Ojembarrena A, Biasucci DG, Bos LDJ, Bouhemad B, Cantinotti M, Ciuca I, Corradi F, Girard M, Gregorio-Hernandez R, Gualano MR, Mojoli F, Ntoumenopoulos G, Pisani L, Raimondi F, Rodriguez-Fanjul J, Savoia M, Smit MR, Tuinman PR, Zieleskiewicz L, De Luca D. ESICM-ESPNIC international expert consensus on quantitative lung ultrasound in intensive care. Intensive Care Med 2025:10.1007/s00134-025-07932-y. [PMID: 40353867 DOI: 10.1007/s00134-025-07932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/28/2025] [Indexed: 05/14/2025]
Abstract
PURPOSE To provide an international expert consensus on technical aspects and clinical applications of quantitative lung ultrasound in adult, paediatric and neonatal intensive care. METHODS The European Society of Intensive Care (ESICM) and the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) endorsed the project. We selected an international panel of 20 adult, paediatric and neonatal intensive care experts with clinical and research expertise in quantitative lung ultrasound, plus two non-voting methodologists. Fourteen clinical questions were proposed by the chairs to the panel, who voted for their priority (1-9 Likert-type scale) and proposed modifications/supplementing (two-round vote). All the questions achieved the predefined threshold (mean score > 5) and 14 groups of 3 mixed adult/paediatric experts were identified to develop the statements for each clinical question; predefined groups of experts in the fields of adult and paediatric/neonatal intensive care voted statements specific for these subgroups. An iterative approach was used to obtain the final consensus statements (two-round vote, 1-9 Likert-type scale); statements were classified as with agreement (range 7-9), uncertainty (4-6), disagreement (1-3) when the median score and ≥ 75% of votes laid within a specific range. RESULTS A total of 46 statements were produced (4 adults-only, 4 paediatric/neonatal-only, 38 interdisciplinary); all obtained agreement. This result was also achieved by acknowledging in the statements the current limitations of quantitative lung ultrasound. CONCLUSION This consensus guides the use of quantitative lung ultrasound in adult, paediatric and neonatal intensive care and helps identify the fields where further research will be needed in the future.
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Affiliation(s)
- Silvia Mongodi
- Intensive Care Unit 1, San Matteo Hospital, Pavia, Italy.
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency Policlinico Paolo Giaccone, Palermo, Italy
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Research Unit, Biomedical Research and Innovation Institute of Cádiz, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, Tor Vergata' University of Rome, Rome, Italy
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
- Université Bourgogne Franche‑Comté, LNC UMR866, Dijon, France
| | - Massimo Cantinotti
- Fondazione CNR Regione Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy
| | - Ioana Ciuca
- Pediatric Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Pediatric Pulmonology Unit, Clinical County Hospital Timisoara, Timisoara, Romania
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Martin Girard
- Department of Anesthesiology, Centre Hospitalier de L'Université de Montréal, Montréal, Canada
- Imaging and Engineering, Centre de Recherche du Centre Hospitalier de L'Université de Montréal, Montréal, Canada
| | | | - Maria Rosaria Gualano
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
- Leadership Research Center, Università Cattolica del Sacro Cuore-Campus Di Roma, Rome, Italy
| | - Francesco Mojoli
- Intensive Care Unit 1, San Matteo Hospital, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
| | | | - Luigi Pisani
- Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari "Aldo Moro", Bari, Italy
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Javier Rodriguez-Fanjul
- Pediatric Intensive Care Unit. Hospital Germans Trias I Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marilena Savoia
- Neonatal Intensive Care Unit, S Maria Della Misericordia Hospital, Udine, Italy
| | - Marry R Smit
- Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
| | - Laurent Zieleskiewicz
- Department of Anesthesia and Critical Care, North Hospital, Marseille APHM, Aix Marseille University, Marseille, France
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP-Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
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3
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Surak A, Shaireen H, Elsayed Y. Applications of lung ultrasound as an emerging tool in neonates. J Neonatal Perinatal Med 2025; 18:187-196. [PMID: 40340483 DOI: 10.1177/19345798251325492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
Lung ultrasound is increasingly used in neonatal intensive care units. We summarized the ultrasonographic patterns, features of most neonatal respiratory morbidities, and clinical application in neonates. Lung ultrasound is a non-invasive, radiation-free, and reproducible adjunct tool that can guide the clinical management of neonates presenting with respiratory distress.
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Affiliation(s)
- Aimann Surak
- Section of Neonatology, Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Huma Shaireen
- Section of Neonatology, Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Yasser Elsayed
- Section of Neonatology, Department of Paediatrics, University of Manitoba, Winnipeg, MB, Canada
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Rigotti C, Zannin E, Chiaraluce S, Ventura ML. Lung function response to postnatal corticosteroids for the prevention and treatment of bronchopulmonary dysplasia. Pediatr Res 2025; 97:1605-1611. [PMID: 39242937 DOI: 10.1038/s41390-024-03535-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/24/2024] [Accepted: 08/19/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Steroid treatment is well-known for producing clinically significant improvements in respiratory support requirements. In this study, we utilized lung ultrasound and respiratory oscillometry to objectively assess this response and determine if the combination of these methods can serve as a valuable tool for comparing different treatment strategies. METHODS We conducted a retrospective observational study including preterm infants with a gestational age below 32 weeks and/or a birth weight below 1500 g. We measured lung ultrasound score (LUS) and respiratory system reactance (Xrs) by respiratory oscillometry before and after treatment with either systemic dexamethasone or inhaled budesonide. RESULTS We analyzed 46 treatments (9 dexamethasone, 37 budesonide) administered to 40 infants (median (Q1, Q3) postnatal age = 30 (18, 49) days, postmenstrual age = 33.29 (30.14, 35.00) weeks). All treatments were associated with a notable reduction in respiratory support and a concurrent improvement in either Xrs, LUS, or both. On average, Xrs improved from 3.13 (1.09, 5.41) to 0.44 (-0.90, 1.59) z-score (p < 0.001) and LUS from 10 (7, 12) to 5 (3, 8) (p < 0.001). CONCLUSIONS Xrs and LUS proved sensitive to lung function changes associated with corticosteroids; combining the two better described the response and its variability. IMPACT We found that respiratory system reactance (Xrs) and lung ultrasound score (LUS) are sensitive biomarker for monitoring changes in lung function associated with corticosteroids; Combining Xrs and LUS enhances evaluation compared to each method alone; These results have valuable implications in clinical practice, particularly in personalizing and monitoring corticosteroid treatment; The present paper suggests that the combined use of respiratory oscillometry and lung ultrasound holds value as a research tool in future studies investigating various treatment regimens, molecules, or administration routes.
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Affiliation(s)
- Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Sofia Chiaraluce
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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5
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Sartorius V, Brunet S, De Luca D. Characteristics of scores used for quantitative lung ultrasound in neonates: a systematic review. Eur Respir Rev 2025; 34:240232. [PMID: 40240059 PMCID: PMC12000906 DOI: 10.1183/16000617.0232-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Accepted: 02/12/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Quantitative lung ultrasound is increasingly being used in neonatology. The aim of this study is to identify the lung ultrasound scores (LUS) available for use in neonates, describe their characteristics and determine which LUS are most used and validated. METHODS A systematic review of the literature was conducted following PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols extension for reporting literature searches in systematic reviews) guidelines. Articles describing LUS in newborn animals and human neonates, published up to March 2024, were searched in the PubMed and Embase databases. RESULTS Out of 757 identified studies, 121 were included. Most of the articles were published in the past 5 years, predominantly by European investigators. They described 32 different LUS. Only 10 (31.4%) of these LUS had undergone at least one validation attempt and only 15 (48.4%) used the four-step scoring scale (i.e. scored from 0 to 3) based on classical lung ultrasound patterns originally described and well established in adult critical care medicine. The most common (49 (40.5%) of all the articles) neonatal score (published by Brat et al. in 2015) was based on this classical grading system. The most commonly used score was also validated using the greatest number of techniques and applied to all major neonatal respiratory disorders. Its simplified version is used to analyse six chest areas (anterior and lateral) to guide surfactant administration, while its extended version includes 10 areas by adding four posterior ones. CONCLUSIONS The most commonly used and validated score, consistent with adult critical care practice, should be the standard for assessing lung aeration in neonates.
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Affiliation(s)
- Victor Sartorius
- Department of Neonatal Intensive Care, Hôpital Necker Enfants-Malades, Université Paris-Cité, APHP, Paris, France
| | - Stéphanie Brunet
- Department of Neonatal Intensive Care, Hôpital Necker Enfants-Malades, Université Paris-Cité, APHP, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
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De Luca D, Neri C, Centorrino R. Update on nasal high frequency oscillatory ventilation: A living review. Semin Perinatol 2025:152056. [PMID: 40011092 DOI: 10.1016/j.semperi.2025.152056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Revised: 02/10/2025] [Accepted: 02/13/2025] [Indexed: 02/28/2025]
Abstract
Non-invasive high-frequency oscillatory ventilation (NHFOV) is the main non-conventional ventilatory mode used in newborn infants. NHFOV has been spreading, while knowledge about its physiology, mechanics and clinical application has increased overtime. This is to be considered as a living review, since we here update the knowledge that was originally summarized in a previously published review. We first focus on physiology of such a complex respiratory support technique with practical data on interfaces, patient-ventilator interaction and devices to provide NHFOV. We then move to the evidence-based review of parallel randomized clinical trial published so far. We provide both qualitative and quantitative synthesis of results for the two commonest outcomes, i.e. need for intubation and invasive ventilation and CO2 elimination. We also provide our protocol to use NHFOV together with other respiratory support modes and we provide suggestions on parameters boundaries and identification of patients to treat. We finally identify still open questions needing future research to optimize the use of NHFOV In preterm infants.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France, Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, 157 rue de la Porte de Trivaux, 92140 Clamart (Paris-IDF), France.
| | - Costanza Neri
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France
| | - Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.
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7
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Liu J, Inchingolo R, Suryawanshi P, Guo BB, Kurepa D, Cortés RG, Yan W, Chi JH, Acosta CM, Jagła M, Sharma D, Sorantin E, Hsieh KS, Graziani G, Malta B, Woods P, Meng Q, You CM, Kruczek P, Kneyber M, Buda N, Smargiassi A, Lovrenski J, Ren XL, Guo YL, Qiu RX, Razak A, Feletti F. Guidelines for the use of lung ultrasound to optimise the management of neonatal respiratory distress: international expert consensus. BMC Med 2025; 23:114. [PMID: 39988689 PMCID: PMC11849336 DOI: 10.1186/s12916-025-03879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Accepted: 01/16/2025] [Indexed: 02/25/2025] Open
Abstract
BACKGROUND Respiratory distress is the main reason for the admission of infants to the neonatal intensive care unit (NICU). Rapid identification of the causes of respiratory distress and selection of appropriate and effective treatment strategies are important to optimise favourable short- and long-term patient outcomes. Lung ultrasound (LUS) technology has become increasingly important in this field. According to the scientific literature, LUS has high sensitivity (92-99%) and specificity (95-97%) in diagnosing neonatal respiratory distress syndrome. This diagnostic power helps guide timely interventions, such as surfactant therapy and mechanical ventilation. METHODS Our objective was to outline consensus guidelines among an international panel of experts on the use of LUS to support the decision-making process in managing respiratory distress in the NICU. We used a three-round Delphi process. In each Delphi round, 28 panellists rated their level of agreement with each statement using a four-point Likert scale. RESULTS In round 1, the panellists reviewed 30 initially proposed statements. In rounds 2 and 3, the statements were redeveloped based on the reviewers' comments, leading to the final approval of 18 statements. Among the 18 consensus statements, grade A was assigned a value of 10, grade B was assigned a value of 7, and grade C was assigned a value of 1. CONCLUSIONS A panel of experts agreed on 18 statements regarding managing infants with respiratory distress. Using LUS may help design future interventional studies and improve the benchmarking of respiratory care outcomes.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, China.
| | - Riccardo Inchingolo
- UOC Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Pradeep Suryawanshi
- Department of Neonatology, Bharati Vidyapeeth University Medical College, Pune, India
| | - Bin-Bin Guo
- Department of Ultrasound, Sixth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dalibor Kurepa
- Cohen Children's Medical Center, Northwell Health, New York, USA
| | | | - Wei Yan
- Department of Ultrasound, Zhumadian Central Hospital of Henan Province, Zhumadian, China
| | - Jing-Han Chi
- Senior Department of Pediatrics, The Seventh Medical Centerof , PLA General Hospital, Beijing, China
| | - Cecilia M Acosta
- Department of Anesthesia, Hospital Privado de Comunidad, Mar del Plata, Argentina
| | - Mateusz Jagła
- Jagiellonian University Collegium Medicum, Krakow, Poland
| | - Deepak Sharma
- Department of Neonatology, Cradle Children Hospital, Jaipur, Rajasthan, India
| | - Erich Sorantin
- Division of Pediatric Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Kai-Sheng Hsieh
- Children's Hospital, China Medical University, Taichung, Taiwan
| | - Giulia Graziani
- Unità Operativa Di Pediatria E Neonatologia, Ospedale Santa Maria Delle Croci, Ausl Romagna, Ravenna, Italy
| | - Bruna Malta
- Unità Operativa Di Radiologia, Ospedale Santa Maria Delle Croci, Ausl Romagna, Ravenna, Italy
| | | | - Qiong Meng
- Department of Paediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chu-Ming You
- Department of Paediatrics, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Piotr Kruczek
- Department of Neonatology, Czerwiakowski Hospital at Siemiradzki St., Cracow, Poland
| | - Martin Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Critical Care, Anaesthesiology, Perioperative & Emergency Medicine (CAPE), University of Groningen, Groningen, the Netherlands
| | - Natalia Buda
- Simulation Laboratory of Endoscopic and Minimally Invasive Techniques, Medical University of Gdansk, Gdansk, Poland
| | - Andrea Smargiassi
- Dipartimento Neuroscienze, UOC Pneumologia, Organi Di Senso E Torace, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jovan Lovrenski
- Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia
- Institute for Children and Adolescents Health Care of Vojvodina, Novi Sad, Serbia
| | - Xiao-Ling Ren
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
- Department of Neonatology, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Ya-Li Guo
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, No.251 Yaojiayuan Road, Chaoyang District, Beijing, 100026, China
- Department of Neonatology, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Ru-Xin Qiu
- Department of Neonatology, Beijing Chao-Yang District Maternal and Child Healthcare Hospital, Beijing, China
| | - Abdul Razak
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
- Monash Newborn, Monash Children's Hospital, Melbourne, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia
| | - Francesco Feletti
- Dipartimento Di Medicina Traslazionale e per la Romagna, Università Di Ferrara, Ferrara, Italy
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8
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Sett A, Foo G, Ngeow A, Thomas N, Kee PPL, Zayegh A, Hodgson KA, Donath SM, Tingay DG, Davis PG, Manley BJ, Rogerson SR. Predicting extubation failure in preterm infants using lung ultrasound: a diagnostic accuracy study. Arch Dis Child Fetal Neonatal Ed 2025; 110:185-190. [PMID: 39160076 DOI: 10.1136/archdischild-2024-327172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/04/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE To determine the accuracy of pre-extubation lung ultrasound (LUS) to predict reintubation in preterm infants born <32 weeks' gestation. DESIGN Prospective diagnostic accuracy study. SETTING Two neonatal intensive care units. METHODS Anterior and lateral LUS was performed pre-extubation. The primary outcome was the accuracy of LUS scores (range 0-24) to predict reintubation within 72 hours. Secondary outcomes were accuracy in predicting (1) reintubation within 7 days, (2) reintubation stratified by postnatal age and (3) accuracy of lateral imaging only (range 0-12). Pre-specified subgroup analyses were performed in extremely preterm infants born <28 weeks' gestation. Cut-off scores, sensitivities and specificities were calculated using receiver operating characteristic analysis and reported as area under the curves (AUCs). RESULTS One hundred preterm infants with a mean (SD) gestational age of 27.4 (2.2) weeks and birth weight of 1059 (354) g were studied. Thirteen were subsequently reintubated. The AUC (95% CI) of the pre-extubation LUS score for predicting reintubation was 0.63 (0.45-0.80). Accuracy was greater in extremely preterm infants: AUC 0.70 (0.52-0.87) and excellent in infants who were <72 hours of age at the time of extubation: AUC 0.90 (0.77-1.00). Accuracy was poor in infants who were >7 days of age. Lateral imaging alone demonstrated similar accuracy to scanning anterior and lateral regions. CONCLUSIONS In contrast to previous studies, LUS was not a strong predictor of reintubation in preterm infants. Accuracy is increased in extremely preterm infants. Future research should focus on infants at highest risk of extubation failure and consider simpler imaging protocols. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN12621001356853.
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Affiliation(s)
- Arun Sett
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gillian Foo
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Alvin Ngeow
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, NUS Yong Loo Lin School of Medicine, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Niranjan Thomas
- Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Penny P L Kee
- Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amir Zayegh
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kate A Hodgson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brett J Manley
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics, Gynaecology and Newborn Health, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Rojas BS, Procianoy RS, de Souza ACM, Rigodanzo CC, Trindade GS, Furlan SP, Silveira RC. Predicting extubation failure in neonates: The role of lung ultrasound and corrected gestational age in safe weaning in the NICU. Eur J Pediatr 2025; 184:144. [PMID: 39825155 DOI: 10.1007/s00431-025-05977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 12/30/2024] [Accepted: 01/06/2025] [Indexed: 01/20/2025]
Abstract
To evaluate the accuracy of the lung ultrasound score (LUS) in predicting ventilatory weaning failure during neonatal hospitalization in the NICU and to identify factors associated with weaning failure, including corrected gestational age (CGA). This prospective, longitudinal, pragmatic and observational cohort study included neonates on mechanical ventilation for at least 48 h. The primary outcome was the accuracy of lung ultrasound in predicting 3-day weaning failure, with the ROC curve used to determine the best LUS cutoff (sensitivity and specificity). Among 55 neonates, the pre-extubation LUS did not show statistical significance in predicting weaning failure (AUC 0.61; 95% CI: 0.46-0.76, p = 0,169). In the subgroup analysis, a score ≥ 4 suggests the need for ventilatory support after extubation (area under the curve [AUC] = 0.91, 95% CI: 0.80-1.0, p < 0.001) in neonates with GA ≥ 28 weeks. In extremely preterm infants, the pre-extubation LUS was not statistically significant in predicting weaning failure (AUC = 0.38, 95% CI: 0-0.77, p = 0.535). In contrast, CGA ≥ 28.7 weeks at extubation was predictor of successful weaning within 3 days (AUC = 0.95, 95% CI: 0.85-1.0, p < 0.001). CONCLUSION LUS show promise in predicting weaning failure, though its accuracy may be limited in extremely preterm infants, highlighting the need for further well-powered studies. CGA at extubation also emerges as a key consideration in this population, warranting confirmation through robust future research. WHAT IS KNOWN • Identifying the optimal timing for extubation is crucial, as both prolonged mechanical ventilation and failed extubation are linked to increased morbidity. • Lung ultrasound plays a well-established role in diagnosing various neonatal lung pathologies, allowing clinicians to make rapid, bedside decisions for the treatment of newborns. WHAT IS NEW • LUS appears to be accurate in predicting weaning failure, though its accuracy may be lower in extremely preterm infants. • In extremely preterm infants, CGA may play an important role in extubation decision-making. • These findings are hypothesis-generating and warrant further investigation in future studies.
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Affiliation(s)
- Bruna Schafer Rojas
- Hospital de Clinicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil
| | - Renato Soibelmann Procianoy
- Hospital de Clinicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil
- Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil
| | | | - Cristiane Cover Rigodanzo
- Hospital de Clinicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil
| | - Gabriela S Trindade
- Hospital de Clinicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil
| | - Silvana Piazza Furlan
- Hospital de Clinicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil
| | - Rita C Silveira
- Hospital de Clinicas de Porto Alegre, Rua Silva Jardim 1155 # 701, Porto Alegre, RS, 90450-071, Brazil.
- Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Khandelwal S, Datta V, Anand R, Devabathina NB. Role of lung ultrasound score in early prediction of bronchopulmonary dysplasia in preterm neonates. J Neonatal Perinatal Med 2025; 18:52-60. [PMID: 39973534 DOI: 10.1177/19345798241296329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
BackgroundThe use of lung ultrasound score (LUS) to predict bronchopulmonary dysplasia (BPD) is still evolving. While LUS is widely available and accurate, there is limited evidence from low- and middle-income countries. We aim to assess LUS's predictive ability for BPD in preterm neonates less than 30 weeks gestation.Material and methodsWe enrolled 160 neonates born at <30 weeks of gestation, who required any form of respiratory support at least for 24 h. Six zone LUS was calculated for all the neonates first within 72 h and then weekly till 36 weeks of post-menstrual age (PMA) or discharge, whichever was earlier. After excluding death and missed scans, 112 neonates were categorized as BPD or non-BPD and were analysed for their LUS.ResultNeonates who developed BPD (n = 33) had higher LUS from the first assessment up to nine weeks. An LUS >5 could predict the development of BPD at one week with a sensitivity of 87.88%, specificity 89.87%, and area under ROC Curve (AUC) 0.93, and at two weeks with a sensitivity of 78.79%, specificity of 96.2%, and AUC 0.95. Likewise, at three and four weeks of life, the optimum cutoff of LUS >3 and >2, respectively, predicted the development of BPD with sensitivity 93.99%, specificity 94.94%, and AUC 0.97 at three weeks and sensitivity 87.88%, specificity 92.41 %, and AUC 91.07% at four weeks. Prediction for moderate-severe BPD was also reliable at all scan time points with AUC 0.84 at 1-3 days, 0.91 at one week, 0.92 at two weeks, 0.95 at three weeks, and 0.97 at four weeks, with LUS cutoff >8, >5, >6, >4, and >3, respectively.ConclusionLUS can reliably predict the future development of BPD as early as one week of life and can play an important role in optimizing BPD preventive strategies.
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Affiliation(s)
- Shikha Khandelwal
- Department of Neonatology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Vikram Datta
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
| | - Rama Anand
- Department of Radiology, Lady Hardinge Medical College, New Delhi, India
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Thabet F, Zayani S, Haddad N, Daya A, Nasrallah CB, Chouchane S. Prognostic Role of Lung-Ultrasound Score in Acute Bronchiolitis Patients Treated With High Flow Nasal Cannula: A Prospective Study. Pediatr Pulmonol 2025; 60:e27432. [PMID: 39620374 PMCID: PMC11748104 DOI: 10.1002/ppul.27432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/12/2024] [Accepted: 11/18/2024] [Indexed: 01/22/2025]
Abstract
INTRODUCTION Lung ultrasound (LUS) has emerged as a reliable, noninvasive tool for bedside assessment of acute bronchiolitis (AB) in infants. Its role in guiding therapeutic decisions is increasingly recognized. AIMS This study aimed to determine the predictive value of LUS in identifying infants with AB at risk of HFNC therapy failure. MATERIALS AND METHODS This prospective, single-center study was conducted in the pediatric department of Fattouma Bourguiba Hospital in Monastir from January 2022 to March 2024. Infants under 12 months hospitalized with moderate to severe AB and requiring HFNC therapy were enrolled. LUS was performed within 3-6 h of HFNC initiation and repeated 24 h later. Clinical and laboratory data, including the Wang score and LUS findings, were analyzed to predict HFNC failure. RESULTS Among 124 enrolled infants, 98 (79%) responded successfully to HFNC therapy, while 26 (21%) failed. Baseline characteristics, including age, weight, and clinical symptomes, were comparable between groups, except for a higher Wang score in the failure group (p = 0.008). LUS scores were significantly higher in the failure group on both day 1 and day 2 (p < 0.001), with a more pronounced score progression (p < 0.001). ROC analysis identified a LUS score > 7 on day 1 and > 9 on day 2 as predictive thresholds for HFNC failure. Multivariate analysis confirmed the day 2 LUS score as an independent predictor of HFNC failure (p = 0.022). CONCLUSION LUS is a valuable prognostic tool in infants with AB undergoing HFNC therapy. Incorporating LUS into routine clinical assessments may help predict therapy failure early, allowing timely escalation of care.
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Affiliation(s)
- Farah Thabet
- Pediatric DepartmentFattouma Bourguiba University HospitalMonastirTunisia
| | - Seyfeddine Zayani
- Pediatric DepartmentFattouma Bourguiba University HospitalMonastirTunisia
| | - Nawrass Haddad
- Pediatric DepartmentFattouma Bourguiba University HospitalMonastirTunisia
| | - Abir Daya
- Pediatric DepartmentFattouma Bourguiba University HospitalMonastirTunisia
| | - Cyrine Ben Nasrallah
- Department of Preventive and Epidemiology MedicineFattouma Bourguiba University HospitalMonastirTunisia
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12
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Zhang X, Yang X, Li Y. Lung ultrasound score for prediction of bronchopulmonary dysplasia in newborns: A meta-analysis. Technol Health Care 2025; 33:235-245. [PMID: 39302397 DOI: 10.3233/thc-240832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) ranks among preterm infants' most common and severe respiratory diseases. Lung ultrasound scores (LUS) play a vital role in predicting early BPD and guiding treatment and intervention strategies for affected patients. OBJECTIVE Performed a meta-analysis to assess the diagnostic LUS for newborns with BPD. METHODS Online electronic databases such as MEDLINE, CINAHL, the Cochrane Library, and Web of Science were used to retrieve relevant research until May 2023. A total of 117 literatures were collected, and ten eligible articles were selected for meta-analysis. RESULTS Meta-analysis was performed on 10 studies (1274 neonates). LUS at 7 days after birth (7 days of life, DOL 7) showed good diagnostic accuracy for any type of BPD, moderate and severe BPD. DOL 7 was more accurate in predicting all types of BPD (AUC = 0.87, sensitivity = 0.75, specificity = 0.83) than moderate and severe BPD (AUC = 0.80, sensitivity = 0.69, specificity = 0.79). There was no statistical significance between DOL 7 and DOL 14 in their accuracy for predicting all types of BPD (difference in AUC = 0.04, p= 0.068). There was no notable distinction between DOL 7 and DOL 14 in their accuracy for predicting moderate and severe BPD (difference in AUC =-0.04, p= 0.104). CONCLUSIONS The diagnostic efficacy of LUS on DOL 7 in predicting the occurrence of all types of BDP and moderate-severe BPD is determined. This will facilitate rapid and accurate detection and timely treatment, thereby reducing the risk of neonatal mortality and sequelae.
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Savoia M, Busolini E, Ibarra Rios D, Thomas B, Ruoss JL, McNamara PJ. Integrated Lung Ultrasound and Targeted Neonatal Echocardiography Evaluation in Infants Born Preterm. J Pediatr 2024; 275:114200. [PMID: 39032769 DOI: 10.1016/j.jpeds.2024.114200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Marilena Savoia
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy.
| | - Eva Busolini
- Neonatal Intensive Care Unit, S Maria della Misericordia Hospital, Udine, Italy
| | - Daniel Ibarra Rios
- Division of Neonatology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de México, Mexico, Mexico
| | - Brady Thomas
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
| | - J Lauren Ruoss
- Neonatal Intensive Care Unit, Winnie Palmer Hospital/Orlando Health Regional Hospital, Orlando, Fl
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics, University of Iowa, Iowa City, IA
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Mongodi S, De Luca D. Quantitative Lung Ultrasound and Pediatric Critical Care: Any Excuse Not to Use It? Am J Respir Crit Care Med 2024; 211:10-12. [PMID: 39556412 PMCID: PMC11755367 DOI: 10.1164/rccm.202411-2144ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 11/14/2024] [Indexed: 11/19/2024] Open
Affiliation(s)
- Silvia Mongodi
- IRCCS S Matteo, Anesthesia and Critical Care, Pavia, Lombardia, Italy
| | - Daniele De Luca
- South Paris University Hospitals, "A.Beclere" Medical Center, NICU, Clamart (Paris), France;
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15
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Catozzi C, Modena A, Storti M, Ricci F, Villetti G, De Luca D. Quantitative lung ultrasound findings correlate with radial alveolar count in experimental bronchopulmonary dysplasia. Ultrasound J 2024; 16:46. [PMID: 39466465 PMCID: PMC11519268 DOI: 10.1186/s13089-024-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/22/2024] [Indexed: 10/30/2024] Open
Abstract
We investigated the relationship between the degree of alveolarization and ultrasound-assessed lung aeration in a validated preterm rabbit model of experimental bronchopulmonary dysplasia (BPD). Lung ultrasound findings were heterogeneously abnormal and consisted of zones with interstitial, interstitial-alveolar or consolidated patterns. The median radial alveolar count was 10.1 [8.4-11.5], 7.8 [6.1-9] and 7.3 [1.8-10.1] in rabbits with interstitial, interstitial-alveolar or consolidated ultrasound pattern, respectively (overall p = 0.036). Alveolar count and lung ultrasound score were significantly correlated (ρ = - 0.044 (95%CI: - 1; - 0.143), p = 0.009; τ-b = - 0.362 (95%CI: - 0.6; - 0.1), p = 0.017).
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Affiliation(s)
- Chiara Catozzi
- Neonatology and Pulmonary Rare Disease Unit, Experimental Pharmacology and Translational Science Department Corporate Preclinical R&D, Chiesi Farmaceutici, Parma, Italy
| | - Angelo Modena
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, Novara, Italy
| | - Matteo Storti
- Neonatology and Pulmonary Rare Disease Unit, Experimental Pharmacology and Translational Science Department Corporate Preclinical R&D, Chiesi Farmaceutici, Parma, Italy
| | - Francesca Ricci
- Neonatology and Pulmonary Rare Disease Unit, Experimental Pharmacology and Translational Science Department Corporate Preclinical R&D, Chiesi Farmaceutici, Parma, Italy
| | - Gino Villetti
- Neonatology and Pulmonary Rare Disease Unit, Experimental Pharmacology and Translational Science Department Corporate Preclinical R&D, Chiesi Farmaceutici, Parma, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Beclere" Medical Centre, Paris Saclay University Hospitals, APHP, Paris, France.
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
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16
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Patel J, Weinberger B, Pulju M, Galanti SG, Kasniya G, Gupta V, Kurepa D. Lung Ultrasound Assessment of Regional Distribution of Pulmonary Edema and Atelectasis in Infants with Evolving Bronchopulmonary Dysplasia. Diagnostics (Basel) 2024; 14:2341. [PMID: 39451663 PMCID: PMC11506572 DOI: 10.3390/diagnostics14202341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/08/2024] [Accepted: 10/14/2024] [Indexed: 10/26/2024] Open
Abstract
Background: Preterm infants are at risk for bronchopulmonary dysplasia (BPD) due to prolonged respiratory support. Studies have described differences in the regional distribution of lung ventilation (non-dependent (NDL) vs. dependent (DL)). The aim of this study was to use LUS to compare regional distribution of pulmonary edema and atelectasis in infants with evolving BPD. Methods: We prospectively performed LUS in premature infants with evolving BPD. On each side, three lung areas (NDL/anterior, lateral, and DL/posterior) were examined for the presence of pulmonary edema and atelectasis. Pulmonary edema scores were assigned based on the number of B-lines, and atelectasis scores were assigned based on the presence/absence of atelectasis. Results: 38 premature infants were enrolled. The NDL showed more pulmonary edema and atelectasis compared to the DL (p = 0.003, p = 0.049, respectively) and compared to the lateral lung (p =< 0.001, p = 0.004, respectively). There was no difference between the lateral and DL (p = 0.188, p = 0.156, respectively). There was no difference between the right and the left lung (p = 0.223, p = 0.656, respectively). Conclusions: In this cohort of preterm infants with evolving BPD, lung disease was unevenly distributed, with more pulmonary edema and atelectasis in the NDL regions compared to the DL or lateral regions.
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Affiliation(s)
- Jimikumar Patel
- Division of Newborn Medicine, Department of Pediatrics, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA;
| | - Barry Weinberger
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Margaret Pulju
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Stephanie G. Galanti
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Gangajal Kasniya
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Venkata Gupta
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
| | - Dalibor Kurepa
- Division of Neonatal-Perinatal Medicine, Northwell Health, Cohen Children’s Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 269-71 76th Street, New York City, NY 11041, USA; (B.W.); (M.P.); (S.G.G.); (G.K.); (V.G.)
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17
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Sartorius V, Loi B, Vivalda L, Regiroli G, De La Rubia-Ortega S, Pezza L, Midevaine M, Shankar-Aguilera S, Ben-Ammar R, De Luca D. Effect of different CPAP levels on ultrasound-assessed lung aeration and gas exchange in neonates. Respir Res 2024; 25:375. [PMID: 39420410 PMCID: PMC11488124 DOI: 10.1186/s12931-024-03010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 10/10/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Respiratory distress syndrome (RDS) and transient tachypnoea (TTN) are the two commonest neonatal respiratory disorders. The optimal continuous positive airway pressure (CPAP) to treat them is unknown. We aim to clarify the effect of different CPAP levels on lung aeration and gas exchange in patients with RDS and TTN. METHODS Prospective, observational, pragmatic, physiological cohort study. CPAP was sequentially increased from 4 to 6 and 8 cmH2O and backwards, with interposed wash-out periods. Lung aeration was assessed with a validated neonatal lung ultrasound score. Gas exchange was non-invasively evaluated with transcutaneous monitoring. Ultrasound score and PtcO2/FiO2 ratio were the co-primary outcomes. PtcCO2 and other oxygenation metrics were the secondary outcomes. RESULTS 30 neonates with RDS and 30 with TTN were studied. Each CPAP increment significantly (overall always p < 0.001) improved both lung aeration and oxygenation, but the increase from 6 to 8 cmH2O achieved a small absolute benefit. In RDS patients, the absolute improvements were small and the diagnosis of TTN was significantly associated with greater improvement of lung aeration (β= -1.4 (95%CI: -2.4; -0.3), p = 0.01) and oxygenation (β = 39.6 (95%CI: 4.1; 75.1), p = 0.029). Aeration improved in 16 (53.3%) and 27 (90%) patients in the RDS and TTN groups, respectively (p = 0.034). Lung aeration showed significant hysteresis in TTN patients. Secondary outcomes gave similar results. CONCLUSIONS Increasing CPAP from 4 to 8 cmH2O improves ultrasound-assessed lung aeration and oxygenation in RDS and TTN. The absolute improvements are small when CPAP is beyond 6 cmH2O or for RDS patients.
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Affiliation(s)
- Victor Sartorius
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
| | - Laura Vivalda
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
| | - Giulia Regiroli
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
| | - Sofia De La Rubia-Ortega
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
| | - Lucilla Pezza
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
| | - Manon Midevaine
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
| | - Shivani Shankar-Aguilera
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
| | - Rafik Ben-Ammar
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP - Paris, 157 rue de la Porte de Trivaux, Clamart, 92140, France.
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France.
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Sett A, Dahm SI, Tingay DG. Lung Ultrasound and Regional Heterogeneity: A Bedside Solution to an Underrecognized Problem? Anesthesiology 2024; 141:635-637. [PMID: 39254536 DOI: 10.1097/aln.0000000000005136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Joan Kirner Women's and Children's, Sunshine Hospital, Melbourne, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, Australia
| | - Sophia I Dahm
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Li Z, Mu X, Lv X, Guo Y, Si S, Wu H. Patent ductus arteriosus and the association between lung ultrasound score and bronchopulmonary dysplasia: a secondary analysis of a prospective study. Eur J Pediatr 2024; 183:4309-4317. [PMID: 39073470 DOI: 10.1007/s00431-024-05702-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
Moderate-to-large patent ductus arteriosus (PDA) has been linked to increased risk of bronchopulmonary dysplasia (BPD), while lung ultrasound score (LUS) has been demonstrated to accurately predict BPD. We aimed to investigate the correlation of LUS as a marker of interstitial pulmonary edema and the severity of the ductal shunt in predicting future BPD development in very preterm infants. This secondary analysis of a prospective study recruited preterm infants with gestational age < 30 weeks. LUS on postnatal days 7 and 14, and echocardiographic data [PDA diameter and left atrium-to-aortic root ratio (LA/Ao)] near LUS acquisition were collected. Correlation coefficient, logistics regression analysis, and the area under the receiver operating characteristic (AUROC) procedure were used. A statistically significant and positive correlation existed between LUS and PDA diameter (ρ = 0.415, ρ = 0.581, and p < 0.001) and LA/Ao (ρ = 0.502, ρ = 0.743, and p < 0.001) at postnatal days 7 and 14, respectively, and the correlations of LUS and echocardiographic data were generally stronger in the non-BPD group. In the prediction of BPD, LUS incorporating echocardiographic data at postnatal days 7 obtained significantly higher predictive performance compared to LUS alone (AUROC 0.878 [95% CI 0.801-0.932] vs. AUROC 0.793 [95% CI 0.706-0.865]; Delong test, p = 0.013). CONCLUSIONS There is a statistically significant correlation between LUS and echocardiographic data, suggesting their potential role as early predictors for respiratory outcomes in very preterm infants. WHAT IS KNOWN • Lung ultrasound score (LUS) has shown good reliability in predicting bronchopulmonary dysplasia (BPD) development. • Some echocardiographic data that characterized ventricular function was reported to be used to predict severe BPD. WHAT IS NEW • There is a positive and statistically significant correlation between LUS and echocardiographic data at postnatal days 7 and 14. • The integrated use of LUS and echocardiographic data may have potential value in predicting BPD.
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Affiliation(s)
- Zhenyu Li
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xin Mu
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xiaoming Lv
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Yiyi Guo
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Shuyu Si
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Hui Wu
- Department of Neonatology, Children's Medical Center, The First Hospital of Jilin University, Changchun, 130021, China.
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20
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Loi B, Sartorius V, Vivalda L, Fardi A, Regiroli G, Dellacà R, Ahsani-Nasab S, Vedovelli L, De Luca D. Global and Regional Heterogeneity of Lung Aeration in Neonates with Different Respiratory Disorders: A Physiologic Observational Study. Anesthesiology 2024; 141:719-731. [PMID: 38657112 DOI: 10.1097/aln.0000000000005026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Aeration heterogeneity affects lung stress and influences outcomes in adults with acute respiratory distress syndrome (ARDS). The authors hypothesize that aeration heterogeneity may differ between neonatal respiratory disorders and is associated with oxygenation, so its evaluation may be relevant in managing respiratory support. METHODS This was an observational prospective study. Neonates with respiratory distress syndrome, transient tachypnea of the neonate, evolving bronchopulmonary dysplasia, and neonatal ARDS were enrolled. Quantitative lung ultrasound and transcutaneous blood gas measurements were simultaneously performed. Global aeration heterogeneity (with its intra- and interpatient components) and regional aeration heterogeneity were primary outcomes; oxygenation metrics were the secondary outcomes. RESULTS A total of 230 (50 respiratory distress syndrome, transient tachypnea of the neonate or evolving bronchopulmonary dysplasia, and 80 neonatal ARDS) patients were studied. Intrapatient aeration heterogeneity was higher in transient tachypnea of the neonate (mean ± SD, 61 ± 33%) and evolving bronchopulmonary dysplasia (mean ± SD, 57 ± 20%; P < 0.001), with distinctive aeration distributions. Interpatient aeration heterogeneity was high for all disorders (Gini-Simpson index, between 0.6 and 0.72) except respiratory distress syndrome (Gini-Simpson index, 0.5), whose heterogeneity was significantly lower than all others (P < 0.001). Neonatal ARDS and evolving bronchopulmonary dysplasia had the most diffuse injury and worst gas exchange metrics. Regional aeration heterogeneity was mostly localized in the upper anterior and posterior zones. Aeration heterogeneity and total lung aeration had an exponential relationship (P < 0.001; adj-R2 = 0.62). Aeration heterogeneity is associated with greater total lung aeration (i.e., higher heterogeneity means a relatively higher proportion of normally aerated lung zones, thus greater aeration; P < 0.001; adj-R2 = 0.83) and better oxygenation metrics upon multivariable analyses. CONCLUSIONS Global aeration heterogeneity and regional aeration heterogeneity differ among neonatal respiratory disorders. Transient tachypnea of the neonate and evolving bronchopulmonary dysplasia have the highest intrapatient aeration heterogeneity. Transient tachypnea of the neonate, evolving bronchopulmonary dysplasia, and neonatal ARDS have the highest interpatient aeration heterogeneity, but the latter two have the most diffuse injury and worst gas exchange. Higher aeration heterogeneity is associated with better total lung aeration and oxygenation. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
| | - Victor Sartorius
- Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
| | - Laura Vivalda
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France
| | - Avand Fardi
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France
| | - Giulia Regiroli
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
| | - Raffaele Dellacà
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano University, Milan, Italy
| | | | - Luca Vedovelli
- Biostatistics Laboratory, University of Padua, Padua, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris Saclay University Hospital, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, Paris Saclay University, Paris, France
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21
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Abdelrazek AA, Kamel SM, Elbakry AAE, Elmazzahy EA. Lung ultrasound in early prediction of bronchopulmonary dysplasia in pre-term babies. J Ultrasound 2024; 27:653-662. [PMID: 38907789 PMCID: PMC11333650 DOI: 10.1007/s40477-024-00913-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/28/2024] [Indexed: 06/24/2024] Open
Abstract
PURPOSE Bronchopulmonary dysplasia (BPD) is a respiratory morbidity related to prematurity. Early prediction of BPD allows the selection of patients who would benefit from new therapies. Lung ultrasound (LUS) is a non-invasive diagnostic tool that has proven to be reliable for many neonatal diseases recently. The study aimed to detect the role of LUS in predicting BPD at days 7 and 14 of life in preterm babies. METHODS This was a prospective cohort study that included 95 preterm babies ≤ 34 weeks. Lung ultrasounds were performed on days 7 and 14 of life. RESULTS The mean gestational age of the studied neonates was 30.25 ± 2.21 weeks. The mean birth weight was 1347.66 ± 432.14 gm. Patients who developed BPD had statistically significantly higher LUS scores on both days 7 and 14 of life. At first examination, a LUS score > 8 showed a sensitivity of 83.33% and a specificity of 60.87%, whereas at follow-up, a LUS score > 8 showed a sensitivity of 76.39% and a specificity of 82.61%. The multivariate logistic regression analysis shows that the most important factors associated with BPD were gestational age ≤ 30 weeks, LUS score at first examination > 8, platelets ≤ 245 × 109/L, segment neutrophils ≤ 42%, and CRP > 5 mg/l. CONCLUSIONS The LUS score predicts BPD at 7 and 14 days of life. LUS scores increased with increasing BPD severity. LUS score > 8 was an independent factor in the prediction of BPD.
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Affiliation(s)
| | - Sara Mahmoud Kamel
- Diagnostic and Intervention Radiology Department, Cairo University Hospitals, Kasr Al-Ainy, Cairo, Egypt
| | | | - Esraa Ahmed Elmazzahy
- Department of Pediatrics, Cairo University Children's Hospital, Cairo, Egypt.
- AboulRish Children Hospital, 1 Aly Ibrahim Bash St, Sayeda Zeinab, Cairo, 11617, Egypt.
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22
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Lin X, Zhang H, Wang X, Zhang R, Zhang L, You X, Xiao L, Wu C, Jiang F, Wang J. Proportion of confluent B-Lines predicts respiratory support in term infants shortly after birth. Respir Res 2024; 25:307. [PMID: 39138486 PMCID: PMC11323528 DOI: 10.1186/s12931-024-02944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To develop and evaluate the predictive value of a simplified lung ultrasound (LUS) method for forecasting respiratory support in term infants. METHODS This observational, prospective, diagnostic accuracy study was conducted in a tertiary academic hospital between June and December 2023. A total of 361 neonates underwent LUS examination within 1 h of birth. The proportion of each LUS sign was utilized to predict their respiratory outcomes and compared with the LUS score model. After identifying the best predictive LUS sign, simplified models were created based on different scan regions. The optimal simplified model was selected by comparing its accuracy with both the full model and the LUS score model. RESULTS After three days of follow-up, 91 infants required respiratory support, while 270 remained healthy. The proportion of confluent B-lines demonstrated high predictive accuracy for respiratory support, with an area under the curve (AUC) of 89.1% (95% confidence interval [CI]: 84.5-93.7%). The optimal simplified model involved scanning the R/L 1-4 region, yielding an AUC of 87.5% (95% CI: 82.6-92.3%). Both the full model and the optimal simplified model exhibited higher predictive accuracy compared to the LUS score model. The optimal cut-off value for the simplified model was determined to be 15.9%, with a sensitivity of 76.9% and specificity of 91.9%. CONCLUSIONS The proportion of confluent B-lines in LUS can effectively predict the need for respiratory support in term infants shortly after birth and offers greater reliability than the LUS score model.
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Affiliation(s)
- Xinao Lin
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Hehua Zhang
- Department of Neonatology, Fuyang Women and Children's Hospital, Fuyang, China
| | - Xuefeng Wang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Ruijie Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Lu Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Xueqin You
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Lingling Xiao
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Chuyan Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China.
| | - Jimei Wang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China.
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23
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Puskarz-Gąsowska J, Kruczek P, Hożejowski R, Stefańska M, Błaż W, Sadowska-Krawczenko I, Majewska U, Bokiniec R. Lung Ultrasound Score in Neonatal RDS: Agreement between Sonography Expert and Neonatologists with Varying Levels of Experience. Healthcare (Basel) 2024; 12:1450. [PMID: 39057594 PMCID: PMC11276990 DOI: 10.3390/healthcare12141450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
This study aimed to assess interrater agreement in lung ultrasound scores (LUS) among neonatologists with varying experience levels and an expert sonographer. A post hoc analysis was conducted on data from a prospective multicenter study involving 155 infants born <34 weeks' gestation, all with respiratory distress syndrome. A total of 629 lung scans were performed and video-recorded by 21 point-of-care sonographers, including both experienced (n = 7) and inexperienced (n = 14) evaluators. Subsequently, a blinded expert sonographer re-evaluated the assigned LUS values. The Cohen's kappa statistic for individual pulmonary field assessments ranged from 0.89 to 0.93, indicating nearly perfect agreement. The interclass correlation coefficient (ICC) confirmed excellent reliability on total LUS values, demonstrating similar performance of experienced (ICC = 0.92, 95% CI 0.90-0.94) and inexperienced sonographers (ICC = 0.93, 95% CI 0.92-0.94). This study underscores that lung ultrasound is easily learned, and LUS exhibits outstanding reproducibility, irrespective of the sonographer's level of experience.
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Affiliation(s)
- Joanna Puskarz-Gąsowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, 00-315 Warsaw, Poland; (J.P.-G.); (U.M.); (R.B.)
| | - Piotr Kruczek
- Department of Neonatology, Ujastek Medical Center, 31-752 Cracow, Poland
- Department of Neonatology, Czerwiakowski Hospital at Siemiradzki st., 31-137 Cracow, Poland
| | | | - Małgorzata Stefańska
- Neonatal and Intensive Care Department, F. Chopin District Specialist Hospital, 35-055 Rzeszów, Poland;
| | - Witold Błaż
- Neonatal and Intensive Care Department, Rzeszów Provincial Hospital No. 2, 35-055 Rzeszów, Poland;
- Faculty of Medicine, University of Rzeszów, 35-055 Rzeszów, Poland
| | | | - Urszula Majewska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, 00-315 Warsaw, Poland; (J.P.-G.); (U.M.); (R.B.)
| | - Renata Bokiniec
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, 00-315 Warsaw, Poland; (J.P.-G.); (U.M.); (R.B.)
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24
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Kuitunen I, Räsänen K, Gualano MR, De Luca D. Blinding Assessments in Neonatal Ventilation Meta-Analyses: A Systematic Meta-Epidemiological Review. Neonatology 2024; 121:659-666. [PMID: 38861954 PMCID: PMC11633896 DOI: 10.1159/000539203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/27/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Randomization and blinding are generally important in randomized trials. In neonatology, blinding of ventilation strategies is unfeasible if not impossible and we hypothesized that its importance has been overestimated, while the peculiarities of the neonatal patient and the specific outcomes have not been considered. METHODS For this meta-epidemiological review, we searched PubMed and Scopus databases in November 2023. We included all meta-analyses focusing on ventilation, published in past 5 years, and reporting either mortality or bronchopulmonary dysplasia (BPD) as an outcome. We extracted the information about how the authors had analyzed risk of bias and evidence certainty. RESULTS We screened 494 abstracts and included 40 meta-analyses. Overall, 13 of the 40 reviews assessed blinding properly. Australian and European authors were most likely to perform correct assessment of the blinding (p = 0.03) and the use of RoB 2.0 tool was also associated with proper assessment (p < 0.001). In multivariate regression, the use of RoB 2.0 was the only factor associated with a proper assessment (Beta 0.57 [95% confidence interval: 0.29-0.99]). GRADE ratings were performed in 25 reviews, and the authors downgraded the evidence certainty due to risk of bias in 19 of these and none of these reviews performed the blinding assessment correctly. CONCLUSION In past neonatal evidence syntheses, the role of blinding has been mostly overestimated, which has led to downgrading of evidence certainty. Objective outcomes (such as mortality and BPD) do not need to be downgraded due to lack of blinding, as the knowledge of the received intervention does not influence the outcome assessment.
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Affiliation(s)
- Ilari Kuitunen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland
- Kuopio University Hospital, Department of Pediatrics, Kuopio, Finland
| | - Kati Räsänen
- University of Eastern Finland, Institute of Clinical Medicine and Department of Pediatrics, Kuopio, Finland
- Kuopio University Hospital, Department of Pediatrics, Kuopio, Finland
| | - Maria Rosaria Gualano
- UniCamillus – Saint Camillus International University of Health Sciences, Rome, Italy
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, “A. Beclere” Hospital, APHP-Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
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25
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De Luca D, Foti A, Alonso-Ojembarrena A, Condò V, Capasso L, Raschetti R, Bonadies L, Baraldi E, Mosca F, Raimondi F. Lung Consolidation Depth and Gas Exchange in Different Types of Neonatal Respiratory Failure: The UNION Multicenter Study. Chest 2024; 165:1431-1434. [PMID: 38367957 DOI: 10.1016/j.chest.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/20/2024] [Accepted: 02/11/2024] [Indexed: 02/19/2024] Open
Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris-Saclay, Paris, France; University Hospitals; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris-Saclay, Paris, France; University; the Division of Neonatology, Department of Pediatrics Stanford University, School of Medicine, Stanford, CA.
| | - Anna Foti
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris-Saclay, Paris, France
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Biomedical Research and Innovation Institute of Cádiz, "Puerta del Mar" University Hospital, Cádiz, Spain
| | - Valentina Condò
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università"Federico II" di Napoli; the Neonatal Intensive Care Unit, Naples, Italy
| | - Roberto Raschetti
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bonadies
- Department of Woman's and Child's Health, University Hospital of Padova; and the University of Milan, Padua, Italy
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padova; and the University of Milan, Padua, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Milan, Italy
| | - Francesco Raimondi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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26
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Szymański P, Puskarz-Gąsowska J, Hożejowski R, Stefańska M, Błaż W, Sadowska-Krawczenko I, Majewska U, Tomaszkiewicz A, Piotrowska M, Kusibab-Mytych M, Słowik-Wasyluk N, Kruczek P, Bokiniec R. Prognostic Relevance of the Lung Ultrasound Score: A Multioutcome Study in Infants with Respiratory Distress Syndrome. Am J Perinatol 2024; 41:e2862-e2869. [PMID: 37848043 PMCID: PMC11150063 DOI: 10.1055/s-0043-1775975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/21/2023] [Indexed: 10/19/2023]
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..
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Affiliation(s)
- Piotr Szymański
- Department of Neonatology, Ujastek Medical Center, Cracow, Poland
- Department of Neonatology, Czerwiakowski Hospital at Siemiradzki St., Cracow, Poland
| | | | | | - Małgorzata Stefańska
- Department of Neonatal and Intensive Care, F. Chopin District Specialist Hospital, Rzeszów, Poland
| | - Witold Błaż
- Department of Neonatal and Intensive Care, Rzeszów Provincial Hospital No. 2, Rzeszów, Poland
- Faculty of Medicine, University of Rzeszów, Rzeszów, Poland
| | | | - Urszula Majewska
- Department of Neonatal and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Anna Tomaszkiewicz
- Department of Neonatology, Ujastek Medical Center, Cracow, Poland
- Department of Neonatal and Intensive Care, Rzeszów Provincial Hospital No. 2, Rzeszów, Poland
| | | | - Marta Kusibab-Mytych
- Department of Neonatal and Intensive Care, F. Chopin District Specialist Hospital, Rzeszów, Poland
| | - Natalia Słowik-Wasyluk
- Department of Neonatal and Intensive Care, Rzeszów Provincial Hospital No. 2, Rzeszów, Poland
| | - Piotr Kruczek
- Department of Neonatology, Ujastek Medical Center, Cracow, Poland
- Department of Neonatology, Czerwiakowski Hospital at Siemiradzki St., Cracow, Poland
| | - Renata Bokiniec
- Department of Neonatal and Intensive Care, Medical University of Warsaw, Warsaw, Poland
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Ghanem M, Zozaya C, Ibrahim J, Lee S, Mohsen N, Nasef N, Mohamed A. Correlation between early postnatal body weight changes and lung ultrasound scores as predictors of bronchopulmonary dysplasia in preterm infants: A secondary analysis of a prospective study. Eur J Pediatr 2024; 183:2123-2130. [PMID: 38363393 DOI: 10.1007/s00431-024-05464-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/17/2024]
Abstract
Recent research links early weight changes (EWC) with bronchopulmonary dysplasia (BPD) in preterm neonates, while lung ultrasound score (LUS) has shown promise in predicting BPD. We aimed to explore the correlation between LUS and EWC as markers of extravascular lung edema and to investigate the correlation between LUS and EWC in preterm infants with respiratory distress syndrome regarding future BPD development. This secondary analysis of a prospective study involved infants ≤ 28 weeks gestation. Enrolled infants underwent lung ultrasound assessment on postnatal days 3, 7 and 14, measuring LUS. EWC was computed on the same time points. Infants were classified as either having BPD or not. Descriptive statistics, correlation coefficient, and area under the receiver operating characteristic (AUROC) curve analysis were utilized. Of 132 infants, 70 (53%) had BPD. Univariate analysis revealed statistically significant differences in LUS and EWC at days 3, 7, and 14 between BPD and no-BPD groups (p < 0.001). A statistically significant but weak positive correlation existed between LUS and EWC (r0.37, r0.29, r0.24, and p < 0.01) at postnatal days 3, 7, and 14, respectively. AUROC analysis indicated LUS having superior predictive capacity for the need for invasive mechanical ventilation at day 14 as well as the later BPD development compared to EWC (p < 0.0001). CONCLUSION In a cohort of extreme preterm infants, our study revealed a positive yet weak correlation between LUS and EWC, suggesting that EWC was not the major contributing to the evolving chronic lung disease. WHAT IS KNOWN • Recent evidence links Early Weight-Changes with bronchopulmonary dysplasia in preterm neonates. • Lung ultrasound score has shown promise in early prediction of the subsequent development of bronchopulmonary dysplasia in preterm infants. No studies have examined the correlation between Early Weight-Changes and Lung ultrasound score in preterm infants during first 2 weeks after birth. WHAT IS NEW • Our study demonstrated a positive and statistically significant correlation between early LUS and EWC, indicating their potential role as early predictors for the subsequent development of BPD in extreme preterm infants. • The weak correlation between the two parameters may stem from the possible restricted influence of EWC, given that it may not be the primary factor contributing to the evolving chronic lung disease.
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Affiliation(s)
- Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Carlos Zozaya
- Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain
| | - Jenna Ibrahim
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Seungwoo Lee
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada
| | - Nada Mohsen
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, ON, M5G 1X5, Canada.
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28
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De Luca D, Bonadies L, Alonso-Ojembarrena A, Martino D, Gutierrez-Rosa I, Loi B, Dasani R, Capasso L, Baraldi E, Davis A, Raimondi F. Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later. JAMA Netw Open 2024; 7:e2413446. [PMID: 38805223 PMCID: PMC11134216 DOI: 10.1001/jamanetworkopen.2024.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 05/29/2024] Open
Abstract
Importance Surfactant 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. Objective To 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 Participants This 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. Exposure Point-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 Measures The 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. Results A 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 < .001) and OSI (adjusted β, 0.2; 95% CI, 0.1-0.3; P < .001). Conclusions and Relevance In 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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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Hospital, AP-HP–Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit–INSERM U999, Paris Saclay University, Paris, France
| | - Luca Bonadies
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova and Institute of Pediatric Research “Città della Speranza,” Padua, Italy
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Diletta Martino
- Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Hospital, AP-HP–Paris Saclay University, Paris, France
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova and Institute of Pediatric Research “Città della Speranza,” Padua, Italy
| | - Irene Gutierrez-Rosa
- Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Hospital, AP-HP–Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit–INSERM U999, Paris Saclay University, Paris, France
| | - Reedhi Dasani
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, School of Medicine, Palo Alto, California
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health, University Hospital of Padova and Institute of Pediatric Research “Città della Speranza,” Padua, Italy
| | - Alexis Davis
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, School of Medicine, Palo Alto, California
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Ozdemir M, Tepe T, Ozlu F, Yapicioglu H, Atmıs A, Demir F, Unal I, Narli N. Lung ultrasound score in the decision of patent ductus arteriosus closure in neonates. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:415-425. [PMID: 38385619 DOI: 10.1002/jcu.23653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 02/10/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE We aimed to investigate the role of lung ultrasound (LUS) score in the closure of hemodynamically insignificant patent ductus arteriosus (PDA) and the clinical findings of the patients before and after closure. METHODS The study groups (107 preterm neonates under 34 gestational weeks) were classified as hemodynamically significant PDA (group 1), hemodynamically insignificant PDA with closure therapy (group 2), hemodynamically insignificant PDA without closure therapy (group 3), and no PDA group (group 4) based on the echocardiography. 6- and 10-region LUS scores were compared for each group. RESULTS There was a significant difference between groups 1 and 3 on first, third, and seventh days. In contrast, groups 1 and 2 had similar LUS scores on the first, third, and seventh days. There was a negative correlation between LUS scores on the first and third days and gestational age, birth weight, the first- and fifth-minute APGAR scores, and there was a positive correlation between aortic root to left atrium ratio, and PDA diameter/weight ratio. CONCLUSION We observed that LUS scores in patients with hemodynamically insignificant PDA treated with closure therapy were similar to in patients with hemodynamically significant PDA. Thus, LUS score can have role in PDA closure in preterm neonates. However, more comprehensive studies are needed.
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Affiliation(s)
- Mustafa Ozdemir
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Tugay Tepe
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Ferda Ozlu
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Hacer Yapicioglu
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
| | - Anıl Atmıs
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Cukurova University, Adana, Turkey
| | - Fadli Demir
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, Cukurova University, Adana, Turkey
| | - Ilker Unal
- Faculty of Medicine, Department of Biostatistics, Cukurova University, Adana, Turkey
| | - Nejat Narli
- Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey
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Sikdar O, Harris C, Greenough A. Improving early diagnosis of bronchopulmonary dysplasia. Expert Rev Respir Med 2024; 18:283-294. [PMID: 38875260 DOI: 10.1080/17476348.2024.2367584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Bronchopulmonary disease (BPD) is associated with long-term neurodevelopmental and cardiorespiratory complications, often requiring significant use of resources. To reduce this healthcare burden, it is essential that those at high risk of BPD are identified early so that strategies are introduced to prevent disease progression. Our aim was to discuss potential methods for improving early diagnosis in the first week after birth. AREAS COVERED A narrative review was undertaken. The search strategy involved searching PubMed, Embase and Cochrane databases from 1967 to 2024. The results of potential biomarkers and imaging modes are discussed. Furthermore, the value of scoring systems is explored. EXPERT OPINION BPD occurs as a result of disruption to pulmonary vascular and alveolar development, thus abnormal levels of factors regulating those processes are promising avenues to explore with regard to early detection of high-risk infants. Data from twin studies suggests genetic factors can be attributed to 82% of the observed difference in moderate to severe BPD, but large genome-wide studies have yielded conflicting results. Comparative studies are required to determine which biomarker or imaging mode may most accurately diagnose early BPD development. Models which include the most predictive factors should be evaluated going forward.
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Affiliation(s)
- Oishi Sikdar
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christopher Harris
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Huang D, You C, Mai X, Li L, Meng Q, Liang Z. Lung ultrasound-guided fluid resuscitation in neonatal septic shock: A randomized controlled trial. Eur J Pediatr 2024; 183:1255-1263. [PMID: 38095714 DOI: 10.1007/s00431-023-05371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 03/20/2024]
Abstract
This randomized controlled trial aimed to determine whether lung ultrasound-guided fluid resuscitation improves the clinical outcomes of neonates with septic shock. Seventy-two patients were randomly assigned to undergo treatment with lung ultrasound-guided fluid resuscitation (LUGFR), or with usual fluid resuscitation (Control) in the first 6 h since the start of the sepsis treatment. The primary study outcome was 14-day mortality after randomization. Fourteen-day mortalities in the two groups were not significantly different (LUGFR group, 13.89%; control group, 16.67%; p = 0.76; hazard ratio 0.81 [95% CI 0.27-2.50]). The LUGFR group experienced shorter length of neonatal intensive care unit (NICU) stays (21 vs. 26 days, p = 0.04) and hospital stays (32 vs. 39 days, p = 0.01), and less fluid was used in the first 6 h (77 vs. 106 mL/kg, p = 0.02). Further, our study found that ultrasound-guided fluid resuscitation can significantly reduce the incidence of acute kidney injury (25% vs. 47.2%, p = 0.05) and intracranial hemorrhage (grades I-II) within 72 h (13.9% vs. 36.1%, p = 0.03). However, no significant difference was found in the resolution of shock within 1 h or 6 h, use of mechanical ventilation or vasopressor support, time to achieve lactate level < 2 mmol/L, and the number of participants developing hepatomegaly in the first 6 h. CONCLUSION Lung ultrasound is a noninvasive and convenient tool for predicting fluid overload in neonatal septic shock. Fluid resuscitation guided by lung ultrasound can shorten the length of hospital and NICU stays, reduce the amount of fluid used in the first 6 h, and reduce the risk of acute kidney injury and intracranial hemorrhage. TRIAL REGISTRATION Registered in Guangdong Second Provincial General Hospital: 2021-IIT-156-EK, date of registration: November 13, 2021. And ClinicalTrials.gov: NCT06144463 (retrospectively registered). WHAT IS KNOWN • Excessive fluid resuscitation in neonates with septic shock had worse outcomes. WHAT IS NEW • Lung ultrasound should be routinely used to guide fluid resuscitation in neonatal septic shock.
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Affiliation(s)
- Dabin Huang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chuming You
- Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China
| | - Xiaowei Mai
- Department of Emergency, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Lin Li
- Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China
| | - Qiong Meng
- Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China.
| | - Zhenyu Liang
- Department of Pediatrics, Guangdong Second Provincial General Hospital, 466 Newport Middle Road, Haizhu District, Guangzhou, 510317, Guangdong Province, China.
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Rigotti C, Zannin E, Dellacà RL, Ventura ML. Combining lung ultrasound and oscillatory mechanics for assessing lung disease in very preterm infants. Pediatr Res 2024; 95:1022-1027. [PMID: 37857847 DOI: 10.1038/s41390-023-02829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND We investigated whether combining lung ultrasound scores (LUSs) and respiratory system reactance (Xrs) measured by respiratory oscillometry explains the severity of lung disease better than individual parameters alone. METHODS We performed a prospective observational study in very preterm infants. Forced oscillations (10 Hz) were applied using a neonatal mechanical ventilator (Fabian HFOi, Vyaire). We used the simultaneous respiratory severity score (RSS = mean airway pressure × FIO2) as a primary outcome. We built linear mixed-effect models to assess the relationship between Xrs z-score, LUS and RSS and compared nested models using the likelihood ratio test (LRT). RESULTS We enrolled 61 infants (median (Q1, Q3) gestational age = 30.00 (26.86, 31.00) weeks) and performed 243 measurements at a postnatal age of 26 (13, 41) days and postmenstrual age of 33.14 (30.46, 35.86) weeks. Xrs z-score and LUS were independently associated with simultaneous RSS (p < 0.001 for both). The model including Xrs and LUS explained the RSS significantly better than Xrs (p value LRT < 0.001) or LUS alone (p value LRT < 0.001). CONCLUSIONS Combining LUS and Xrs z-score explains the severity of lung disease better than each parameter alone and has the potential to improve the understanding of the underlying pathophysiology. IMPACT Combining respiratory system reactance by oscillometry and lung ultrasound score explains the respiratory support requirement (e.g., proxy of the severity of lung disease) significantly better than each parameter alone. We assessed the relationship between lung ultrasound and respiratory system reactance in very preterm infants for the first time. Combining respiratory oscillometry and lung ultrasound has the potential to improve the understanding of respiratory pathophysiology.
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Affiliation(s)
- Camilla Rigotti
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Raffaele L Dellacà
- TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Sett A, Foo GWC, Tingay DG, Badurdeen S. The best of both worlds: Refining respiratory phenotypes through combined non-invasive lung monitoring. Pediatr Res 2024; 95:877-879. [PMID: 37978316 DOI: 10.1038/s41390-023-02910-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- Joan Kirner Women's and Children's, Sunshine Hospital, Melbourne, VIC, Australia.
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, VIC, Australia.
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, Australia.
| | - Gillian W C Foo
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Joan Kirner Women's and Children's, Sunshine Hospital, Melbourne, VIC, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Shiraz Badurdeen
- Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Melbourne, VIC, Australia
- Melbourne Children's Global Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Mercy Hospital for Women's, Melbourne, VIC, Australia
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Chidini G, Raimondi F. Lung ultrasound for the sick child: less harm and more information than a radiograph. Eur J Pediatr 2024; 183:1079-1089. [PMID: 38127086 DOI: 10.1007/s00431-023-05377-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
In the realm of emergency medicine, the swift adoption of lung ultrasound (LU) has extended from the adult population to encompass pediatric and neonatal intensivists. LU stands out as a bedside, replicable, and cost-effective modality, distinct in its avoidance of ionizing radiations, a departure from conventional chest radiography. Recent years have witnessed a seamless adaptation of experiences gained in the adult setting to the neonatal and pediatric contexts, underscoring the versatility of bedside Point of care ultrasound (POCUS). This adaptability has proven reliable in diagnosing common pathologies and executing therapeutic interventions, including chest drainage, and central and peripheral vascular cannulation. The surge in POCUS utilization among neonatologists and pediatric intensivists is notable, spanning economically advanced Western nations with sophisticated, high-cost intensive care facilities and extending to low-income countries. Within the neonatal and pediatric population, POCUS has become integral for diagnosing and monitoring respiratory infections and chronic and acute lung pathologies. This, in turn, contributes to a reduction in radiation exposure during critical periods of growth, thereby mitigating oncological risks. Collaboration among various national and international societies has led to the formulation of guidelines addressing both the clinical application and regulatory aspects of operator training. Nevertheless, unified guidelines specific to the pediatric and neonatal population remain lacking, in contrast to the well-established protocols for adults. The initial application of POCUS in neonatal and pediatric settings centered on goal-directed echocardiography. Pivotal developments include expert statements in 2011, the UK consensus statement on echocardiography by neonatologists, and European training recommendations. The Australian Clinician Performed Ultrasound (CPU) program has played a crucial role, providing a robust academic curriculum tailored for training neonatologists in cerebral and cardiac assessment. Notably, the European Society for Paediatric and Neonatal Intensive Care (ESPNIC) recently disseminated evidence-based guidelines through an international panel, delineating the use and applications of POCUS in the pediatric setting. These guidelines are pertinent to any professional tending to critically ill children in routine or emergency scenarios. In light of the burgeoning literature, this paper will succinctly elucidate the methodology of performing an LU scan and underscore its primary indications in the neonatal and pediatric patient cohort. The focal points of this review comprise as follows: (1) methodology for conducting a lung ultrasound scan, (2) key ultrasonographic features characterizing a healthy lung, and (3) the functional approach: Lung Ultrasound Score in the child and the neonate. Conclusion: the aim of this review is to discuss the following key points: 1. How to perform a lung ultrasound scan 2. Main ultrasonographic features of the healthy lung 3. The functional approach: Lung Ultrasound Score in the child and the neonate What is Known: • Lung Ultrasound (LUS) is applied in pediatric and neonatal age for the diagnosis of pneumothorax, consolidation, and pleural effusion. • Recently, LUS has been introduced into clinical practice as a bedside diagnostic method for monitoring surfactant use in NARDS and lung recruitment in PARDS. What is New: • Lung Ultrasound (LUS) has proven to be useful in confirming diagnoses of pneumothorax, consolidation, and pleural effusion. • Furthermore, it has demonstrated effectiveness in monitoring the response to surfactant therapy in neonates, in staging the severity of bronchiolitis, and in PARDS.
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Affiliation(s)
- Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Anaesthesia, Intensive Care and Emergency Medicine Department, Milan, Italy.
| | - Francesco Raimondi
- Neonatal Intensive Care Unit, Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
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Huang C, Zhang S, Ha X, Cui Y, Zhang H. The value of lung ultrasound score in neonatal respiratory distress syndrome: a prospective diagnostic cohort study. Front Med (Lausanne) 2024; 11:1357944. [PMID: 38390571 PMCID: PMC10881781 DOI: 10.3389/fmed.2024.1357944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Rationale The accurate diagnosis of critically ill patients with respiratory failure can be achieved through lung ultrasound (LUS) score. Considering its characteristics, it is speculated that this technique might also be useful for patients with neonatal respiratory distress syndrome (NRDS). Thus, there is a need for precise imaging tools to monitor such patients. Objectives This double-blind randomized cohort study aims to investigate the impact of LUS and related scores on the severity of NRDS patients. Methods This study was conducted as a prospective double-blind randomized study. Bivariate correlation analysis was conducted to investigate the relationship between LUS score and Oxygenation Index (OI), Respiratory Index (RI), and Sequential Organ Failure Assessment (SOFA) score. Spearman's correlation coefficient was used to generate correlation heat maps, elucidating the associations between LUS and respective parameters in different cohorts. Receiver Operating Characteristic (ROC) curves were employed to calculate the predictive values, sensitivity, and specificity of different scores in determining the severity of NRDS. Results This study ultimately included 134 patients admitted to the intensive care unit (ICU) between December 2020 and June 2022. Among these patients, 72 were included in the NRDS cohort, while 62 were included in the Non-NRDS (N-NRDS) cohort. There were significant differences in the mean LUS scores between NRDS and N-NRDS patients (p < 0.01). The LUS score was significantly negatively correlated with the OI (p < 0.01), while it was significantly positively correlated with the RI and SOFA scores (p < 0.01). The correlation heatmap revealed the highest positive correlation coefficient between LUS and RI (0.82), while the highest negative correlation coefficient was observed between LUS and OI (-0.8). ROC curves for different scores demonstrated that LUS score had the highest area under the curve (0.91, 95% CI: 0.84-0.98) in predicting the severity of patients' conditions. The combination of LUS and other scores can more accurately predict the severity of NRDS patients, with the highest AUC value of 0.93, significantly higher than using a single indicator alone (p < 0.01). Conclusion Our double-blind randomized cohort study demonstrates that LUS, RI, OI, and SOFA scores can effectively monitor the lung ventilation and function in NRDS. Moreover, these parameters and their combination have significant predictive value in evaluating the severity and prognosis of NRDS patients. Therefore, these results provide crucial insights for future research endeavors.
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Affiliation(s)
- Chunyan Huang
- Department of Ultrasound, Yantaishan Hospital, Yantai, China
- Medical Impact and Nuclear Medicine Program, Binzhou Medical University, Yantai, China
| | - Shaoqin Zhang
- Department of Ultrasound, Yantaishan Hospital, Yantai, China
| | - Xiaoming Ha
- Department of Ultrasound, Yantaishan Hospital, Yantai, China
| | - Yanfang Cui
- Department of Ultrasound, Yantaishan Hospital, Yantai, China
| | - Hongxia Zhang
- Department of Ultrasound, Yantaishan Hospital, Yantai, China
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Zong H, Huang Z, Fu Y, Chen X, Yu Y, Huang Y, Huang Y, Sun H, Yang C. Lung ultrasound score as a tool to predict severity of bronchopulmonary dysplasia in neonates born ≤25 weeks of gestational age. J Perinatol 2024; 44:273-279. [PMID: 38087005 DOI: 10.1038/s41372-023-01811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE The primary aim was to evaluate whether the addition of the posterior lung aided in diagnostic accuracy of predicting bronchopulmonary dysplasia (BPD) vs moderate-severe BPD (msBPD); the secondary aim was to explore the diagnostic accuracy of two protocols for BPD vs msBPD. STUDY DESIGN This was a single-center prospective observational study. Preterm infants with a gestational age ≤ 25 weeks were included. Two LUS score protocols were evaluated on the 14th day of life (DOL): (A) evaluating the anterolateral (LUS score-al) lung and (B) the anterolateral combined with posterior (LUS score-alp) lung. The LUS score range for the two protocols was 0-32 and 0-48, respectively. RESULTS A total of eighty-nine infants were enrolled. Both the LUS score-al and LUS score-alp were higher in neonates developing BPD and msBPD than in the rest of the cohort (LUS score-al 24 (23,26) vs 22 (20,23); LUS score-alp 36 (34,39) vs 28 (25,32)) (LUS score-al 25 (24,26) vs 23 (21,24); LUS score-alp 40 (39,40) vs 34 (28,36)). The LUS score-al on the 14th DOL showed a moderate diagnostic accuracy to predict BPD and msBPD (AUC 95% CI: 0.797 [0.697-0.896]; 0.811[0.713-0.909]), while the LUS score-alp significantly improved diagnostic accuracy of BPD and msBPD (AUC 95% CI: 0.902 [0.834-0.970]; 0.922 [0.848-0.996]). A cutoff of 25 points in the LUS score-al provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 76.9%, 79.4%, 3.7, and 0.3 respectively to predict msBPD. Meanwhile, that of 39 points in the LUS score-alp provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 81%, 98.4%, 50.5 and 0.19 to predict msBPD, respectively. CONCLUSIONS The LUS score on the 14th DOL can predict BPD and msBPD with moderate diagnostic accuracy. Apart from that, scanning posterior enhanced diagnostic accuracy.
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Affiliation(s)
- Haifeng Zong
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Zhifeng Huang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Yongping Fu
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Xueyu Chen
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Yanliang Yu
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Yingsui Huang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Yichu Huang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Hongyan Sun
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Chuanzhong Yang
- Neonatal Intensive Care Unit, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
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Vc LK, Patla VKR, Vadije PR, Murki S, Subramanian S, Injeti G, Nagula K, Vadyala M, Garg M, Thirunagari S. Assessing the diagnostic accuracy of lung ultrasound in determining invasive ventilation needs in neonates on non-invasive ventilation: An observational study from a tertiary NICU in India. Eur J Pediatr 2024; 183:939-946. [PMID: 38052734 DOI: 10.1007/s00431-023-05356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Effective management of neonatal respiratory distress requires timely recognition of when to transition from non-invasive to invasive ventilation. Although the lung ultrasound score (LUS) is useful in evaluating disease severity and predicting the need for surfactants, its efficacy in identifying neonates requiring invasive ventilation has only been explored in a few studies. This study aims to assess the accuracy of LUS in determining the need for invasive ventilation in neonates on non-invasive ventilation (NIV) support. From July 2021 to June 2023, we conducted a prospective study on 192 consecutively admitted neonates with respiratory distress needing NIV within 24 h of birth at our NICU in Hyderabad, India. The primary objective was the diagnostic accuracy of LUS in determining the need for invasive ventilation within 72 h of initiating NIV. We calculated LUS using the scoring system of Brat et al. (JAMA Pediatr 169:e151797, [10]). Treating physicians' assessments of the need for invasive ventilation served as the reference standard for evaluating LUS effectiveness. Out of 192 studied neonates, 31 (16.1%) required invasive ventilation. The median LUS was 5 (IQR: 2-8) for those on NIV and 10 (IQR: 7-12) for those needing invasive ventilation. The LUS had a strong discriminative ability for invasive ventilation with an AUC (area under the curve) of 0.825 (CI: 0.75-0.86, p = 0.0001). An LUS > 7 had 77.4% sensitivity (95% CI: 58.9-90.8%), 75.1% specificity (95% CI: 67.8-81.7%), 37.5% positive predictive value (PPV) (95% CI: 30.15-45.5%), 94.5% negative predictive value (NPV) (95% CI: 89.9-97.1%), 3.1 positive likelihood ratio (PLR) (95% CI: 2.2-4.3), 0.3 negative likelihood ratio (NLR) (95% CI: 0.15-0.58), and 75.5% overall accuracy (95% CI: 68.8-81.4%) for identifying invasive ventilation needs. In contrast, SAS, with a cutoff point greater than 5, has an AUC of 0.67. It demonstrates 62.5% sensitivity, 61.9% specificity, 24.7% PPV, 89.2% NPV, and an overall diagnostic accuracy of 61.9%. The DeLong test confirms the significance of this difference (AUC difference: 0.142, p = 0.04), underscoring LUS's greater reliability for NIV failure. Conclusion: This study underscores the diagnostic accuracy of the LUS cutoff of > 7 in determining invasive ventilation needs during the initial 72 h of NIV. Importantly, while lower LUS values typically rule out the need for ventilation, higher values, though indicative, are not definitive. What is known? • The effectiveness of lung ultrasound in evaluating disease severity and the need for surfactants in neonates with respiratory distress is well established. However, traditional indicators for transitioning from non-invasive to invasive ventilation, like respiratory distress and oxygen levels, have limitations, underscoring the need for reliable, non-invasive assessment tools. What is new? • This study reveals that a LUS over 7 accurately discriminates between neonates requiring invasive ventilation and those who do not. Furthermore, the lung ultrasound score outperformed the Silverman Andersen score for NIV failure in our population.
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Affiliation(s)
- Lokesh Kumar Vc
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | | | - Praveen Rao Vadije
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India.
| | - Srinivas Murki
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | - Sreeram Subramanian
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | - Gnanavelu Injeti
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | - Karthikeya Nagula
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | - Mounika Vadyala
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | - Mehak Garg
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
| | - Shivani Thirunagari
- Department of Neonatology, Paramitha Children's Hospital, Hyderabad, Telangana, India
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He LLH, Foo G, Kenna KR, Douglas E, Fatmous M, Sutton RJ, Perkins EJ, Sourial M, Pereira-Fantini PM, Tingay DG, Sett A. Lung ultrasound detects regional aeration inhomogeneity in ventilated preterm lambs. Pediatr Res 2024; 95:129-134. [PMID: 37591926 PMCID: PMC10798896 DOI: 10.1038/s41390-023-02781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Inhomogeneous lung aeration is a significant contributor to preterm lung injury. EIT detects inhomogeneous aeration in the research setting. Whether LUS detects inhomogeneous aeration is unknown. The aim was to determine whether LUS detects regional inhomogeneity identified by EIT in preterm lambs. METHODS LUS and EIT were simultaneously performed on mechanically ventilated preterm lambs. LUS images from non-dependent and dependent regions were acquired and reported using a validated scoring system and computer-assisted quantitative LUS greyscale analysis (Q-LUSMGV). Regional inhomogeneity was calculated by observed over predicted aeration ratio from the EIT reconstructive model. LUS scores and Q-LUSMGV were compared with EIT aeration ratios using one-way ANOVA. RESULTS LUS was performed in 32 lambs (~125d gestation, 128 images). LUS scores were greater in upper anterior (non-dependent) compared to lower lateral (dependent) regions of the left (3.4 vs 2.9, p = 0.1) and right (3.4 vs 2.7, p < 0.0087). The left and right upper regions also had greater LUS scores compared to right lower (3.4 vs 2.7, p < 0.0087) and left lower (3.7 vs 2.9, p = 0.1). Q-LUSMGV yielded similar results. All LUS findings corresponded with EIT regional differences. CONCLUSION LUS may have potential in measuring regional aeration, which should be further explored in human studies. IMPACT Inhomogeneous lung aeration is an important contributor to preterm lung injury, however, tools detecting inhomogeneous aeration at the bedside are limited. Currently, the only tool clinically available to detect this is electrical impedance tomography (EIT), however, its use is largely limited to research. Lung ultrasound (LUS) may play a role in monitoring lung aeration in preterm infants, however, whether it detects inhomogeneous lung aeration is unknown. Visual LUS scores and mean greyscale image analysis using computer assisted quantitative LUS (Q-LUSMGV) detects regional lung aeration differences when compared to EIT. This suggests LUS reliably detects aeration inhomogeneity warranting further investigation in human trials.
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Affiliation(s)
- Laura L H He
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia.
| | - Gillian Foo
- Joan Kirner Women's and Children's Hospital, Western Health, Victoria, VIC, Australia
| | - Kelly R Kenna
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Ellen Douglas
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Monique Fatmous
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Rebecca J Sutton
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Translational Research Unit, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Elizabeth J Perkins
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Magdy Sourial
- Translational Research Unit, Murdoch Children's Research Institute, Victoria, VIC, Australia
| | - Prue M Pereira-Fantini
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia
| | - Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Victoria, VIC, Australia
- Department of Paediatrics, University of Melbourne, Victoria, VIC, Australia
- Joan Kirner Women's and Children's Hospital, Western Health, Victoria, VIC, Australia
- Newborn Research Centre, The Royal Women's Hospital, Victoria, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, VIC, Australia
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Corsini I, Lenzi MB, Ciarcià M, Matina F, Petoello E, Flore AI, Nogara S, Gangemi A, Fusco M, Capasso L, Raimondi F, Rodriguez-Fanjul J, Dani C, Ficial B. Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants. Eur J Pediatr 2023; 182:5375-5383. [PMID: 37740771 DOI: 10.1007/s00431-023-05200-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
Lung ultrasound (LU) has emerged as the imaging technique of choice for the assessment of neonates with respiratory distress syndrome (RDS) at the bedside. Scoring systems were developed to quantify RDS severity and to predict the need for surfactant administration. There is no data on the comparison of the three main LU scores (LUS) proposed by Brat, Raimondi and Rodriguez-Fanjul. Moreover, there is not enough evidence to recommend which score and which cut-off has the best ability to predict surfactant need. The three LUS were compared in terms of ability to predict the need for surfactant and reproducibility in a cohort of very preterm infants. This was an observational, retrospective, multicenter study. Neonates below 32 weeks of gestational age with RDS, on non-invasive ventilation with a LU performed prior to surfactant administration (1-3 h of life) were included. Brat, Raimondi, and Rodriguez-Fanjul's scores were calculated for each patient. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability to predict surfactant administration. K-Cohen test, Bland-Altman, and intraclass correlation coefficients were used to assess the intra and interobserver variability. Fifty-four preterm infants were enrolled. Brat, Raimondi, and Rodriguez-Fanjul scores showed a strong ability to predict the need for surfactant: the AUCs were 0.85 (95% CI 0.74-0.96), 0.85 (95% CI 0.75-0.96), and 0.79 (95% CI 0.67-0.92), respectively. No significant differences have been found between the AUCs using the DeLong test. Brat and Raimondi's scores had an optimal cut-off value > 8, while the Rodriguez-Fanjul's score > 10. The k-Cohen values of intraobserver agreement for Brat, Raimondi, and Rodriguez-Fanjul's scores were 0.896 (0.698-1.000), 1.000 (1.000-1.000), and 0.922 (0.767-1.000), respectively. The k-Cohen values of interobserver agreement were 0.896 (0.698-1.000), 0.911 (0.741-1.000), and 0.833 (0.612-1.000), respectively.Conclusions: The three LUS had an excellent ability to predict the need for surfactant and an optimal intra and interobserver agreement. The differences found between the three scores are minimal with negligible clinical implications. Since the optimal cut-off value differed, the same score should be used consistently within the same center. What is Known: • Lung ultrasound is a useful bedside imaging tool that should be used in the assessment of neonates with RDS • Scoring systems or lung ultrasound scores allow to quantify the severity of the pulmonary disease and to predict the need for surfactant replacement therapy What is New: • The three lung ultrasound scores by Brat, Raimondi and Rodriguez-Fanjul have an excellent ability to predict the need for surfactant replacement therapy, although with different cut-off values • All three lung ultrasound scores had an excellent intra and interobserver reproducibility.
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Affiliation(s)
- Iuri Corsini
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
| | - Maria Beatrice Lenzi
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Martina Ciarcià
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Federico Matina
- Neonatal Intensive Care Unit, Hospital Cervello Palermo, Palermo, Italy
| | - Enrico Petoello
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonella Gangemi
- Neonatal Intensive Care Unit, Hospital Cervello Palermo, Palermo, Italy
| | - Monica Fusco
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Javier Rodriguez-Fanjul
- Neonatology Department, Institut d'Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain
| | - Carlo Dani
- Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
- Department of Neurosciences, Drug Research and Child Health, University of Florence, PsychologyFlorence, Italy
| | - Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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AIUM Official Statement: Statement and Recommendations for Safety Assurance in Lung Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E63-E67. [PMID: 37668294 DOI: 10.1002/jum.16314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023]
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Rigotti C, Zannin E, Dognini G, Dellacà R, Ventura ML. Oscillatory mechanics trajectory in very preterm infants: a cohort study. Pediatr Res 2023; 94:1998-2004. [PMID: 37452113 DOI: 10.1038/s41390-023-02724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/20/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The aim of this study was to describe the trajectory of oscillatory mechanics from the first week of life to term equivalent and evaluate whether oscillatory mechanics are associated with simultaneous lung disease in infants ≤32 weeks gestation. METHODS In this observational, longitudinal study, we enrolled 66 infants. Forced oscillations were applied using a neonatal mechanical ventilator (Fabian HFOi) that superimposed oscillations (10 Hz, amplitude 2.5 cmH2O) on a positive end-expiratory pressure (PEEP). Measurements were performed at 5-7-9 cmH2O of PEEP or the clinical pressure ±2 cmH2O; they were repeated at 7, 14, 28 post-natal days, and 36 and 40 weeks post-menstrual age (PMA). RESULTS The mean (range) gestational age of study participants was 29.2 (22.9-31.9) weeks. Nineteen infants (29%) developed bronchopulmonary dysplasia (BPD). Respiratory system reactance was significantly lower (lower compliance), and respiratory system resistance was significantly higher in infants with developing BPD from 7 post-natal days to 36 weeks PMA. All oscillatory mechanics parameters were significantly associated with the simultaneous respiratory severity score (p < 0.001 for all). CONCLUSIONS Serial measurements of oscillatory mechanics allow differentiating lung function trajectory in infants with and without evolving BPD. Oscillatory mechanics significantly correlate with the severity of simultaneous lung disease. IMPACT The results of the present study suggest that respiratory system reactance, as assessed by respiratory oscillometry, allows the longitudinal monitoring of the progression of lung disease in very premature infants. This paper describes for the first time the trajectory of oscillatory mechanics in very preterm infants with and without evolving bronchopulmonary dysplasia from the first week of life to term equivalent. Serial respiratory oscillometry measurements allow the identification of early markers of evolving bronchopulmonary dysplasia and may help personalizing the respiratory management strategy.
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Affiliation(s)
- Camilla Rigotti
- Tin-neonatologia, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuela Zannin
- Tin-neonatologia, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Giulia Dognini
- Tin-neonatologia, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Raffaele Dellacà
- TechRes Lab, Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milan, Italy
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Corsini I, Rodriguez-Fanjul J, Raimondi F, Boni L, Berardi A, Aldecoa-Bilbao V, Alonso-Ojembarrena A, Ancora G, Aversa S, Beghini R, Meseguer NB, Capasso L, Chesi F, Ciarcià M, Concheiro A, Corvaglia L, Ficial B, Filippi L, Carballal JF, Fusco M, Gatto S, Ginovart G, Gregorio-Hernández R, Lista G, Sánchez-Luna M, Martini S, Massenzi L, Miselli F, Mercadante D, Mosca F, Palacio MT, Perri A, Piano F, Prieto MP, Fernandez LR, Risso FM, Savoia M, Staffler A, Vento G, Dani C. Lung UltrasouNd Guided surfactant therapy in preterm infants: an international multicenter randomized control trial (LUNG study). Trials 2023; 24:706. [PMID: 37925512 PMCID: PMC10625281 DOI: 10.1186/s13063-023-07745-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/24/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND The management of respiratory distress syndrome (RDS) in premature newborns is based on different types of non-invasive respiratory support and on surfactant replacement therapy (SRT) to avoid mechanical ventilation as it may eventually result in lung damage. European guidelines currently recommend SRT only when the fraction of inspired oxygen (FiO2) exceeds 0.30. The literature describes that early SRT decreases the risk of bronchopulmonary dysplasia (BPD) and mortality. Lung ultrasound score (LUS) in preterm infants affected by RDS has proven to be able to predict the need for SRT and different single-center studies have shown that LUS may increase the proportion of infants that received early SRT. Therefore, the aim of this study is to determine if the use of LUS as a decision tool for SRT in preterm infants affected by RDS allows for the reduction of the incidence of BPD or death in the study group. METHODS/DESIGN In this study, 668 spontaneously-breathing preterm infants, born at 25+0 to 29+6 weeks' gestation, in nasal continuous positive airway pressure (nCPAP) will be randomized to receive SRT only when the FiO2 cut-off exceeds 0.3 (control group) or if the LUS score is higher than 8 or the FiO2 requirements exceed 0.3 (study group) (334 infants per arm). The primary outcome will be the difference in proportion of infants with BPD or death in the study group managed compared to the control group. DISCUSSION Based on previous published studies, it seems that LUS may decrease the time to administer surfactant therapy. It is known that early surfactant administration decreases BPD and mortality. Therefore, there is rationale for hypothesizing a reduction in BPD or death in the group of patients in which the decision to administer exogenous surfactant is based on lung ultrasound scores. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05198375 . Registered on 20 January 2022.
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Affiliation(s)
- Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | | | - Francesco Raimondi
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Luca Boni
- SC Epidemiologia Clinica IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Victoria Aldecoa-Bilbao
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | - Salvatore Aversa
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, AOUI Verona, Verona, Italy
| | | | - Letizia Capasso
- Division of Neonatology, Federico II University of Naples, Naples, Italy
| | - Francesca Chesi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Martina Ciarcià
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Ana Concheiro
- Neonatal Intensive Care Unit, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Luca Filippi
- Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jesus Fuentes Carballal
- Neonatal Intensive Care Unit, Complexo Hospitalario Universitario de A Coruña (CHUAC), Coruña, Spain
| | - Monica Fusco
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Sara Gatto
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | - Gemma Ginovart
- Neonatal Intensive Care Unit. Hospital Germans Trias I Pujol, Badalona, Spain
| | | | - Gianluca Lista
- Neonatal Intensive Care Unit, Ospedale Dei Bambini "V.Buzzi", Milan, Italy
| | | | - Silvia Martini
- Neonatal Intensive Care Unit IRCCS AUOBO, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Francesca Miselli
- Neonatal Intensive Care Unit, Policlinico Universitario Modena, Modena, Italy
| | - Domenica Mercadante
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marta Teresa Palacio
- Neonatal Intensive Care Unit, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Francesca Piano
- Neonatal Intensive Care Unit, Ospedale Infermi Di Rimini, Rimini, Italy
| | | | | | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | | | - Giovanni Vento
- Neonatal Intensive Care Unit, Policlinico Gemelli, Rome, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Poh QH, Dahm S, Tingay DG, Sett A. Functional lung morphometry: another piece in the BPD prediction puzzle? Pediatr Res 2023; 94:1593-1595. [PMID: 37353662 PMCID: PMC10624637 DOI: 10.1038/s41390-023-02701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Qi Hui Poh
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sophia Dahm
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - David G Tingay
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Arun Sett
- Neonatal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, St Albans, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
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Parraga G, Sharma M. Don't Forget the Kids!: Novel Pulmonary MRI and AI of Neonatal Lung Disease. Radiol Artif Intell 2023; 5:e230400. [PMID: 38074786 PMCID: PMC10698590 DOI: 10.1148/ryai.230400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2024]
Affiliation(s)
- Grace Parraga
- From the Department of Medical Biophysics, Western University, Robarts Research Institute, 1151 Richmond St, London, ON, Canada N6A 5B7
| | - Maksym Sharma
- From the Department of Medical Biophysics, Western University, Robarts Research Institute, 1151 Richmond St, London, ON, Canada N6A 5B7
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Zini T, Miselli F, Berardi A. Noninvasive Monitoring Strategies for Bronchopulmonary Dysplasia or Post-Prematurity Respiratory Disease: Current Challenges and Future Prospects. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1753. [PMID: 38002844 PMCID: PMC10670116 DOI: 10.3390/children10111753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Definitions of bronchopulmonary dysplasia (BPD) or post-prematurity respiratory disease (PPRD) aim to stratify the risk of mortality and morbidity, with an emphasis on long-term respiratory outcomes. There is no univocal classification of BPD due to its complex multifactorial nature and the substantial heterogeneity of clinical presentation. Currently, there is no definitive treatment available for extremely premature very-low-birth-weight infants with BPD, and challenges in finding targeted preventive therapies persist. However, innovative stem cell-based postnatal therapies targeting BPD-free survival are emerging, which are likely to be offered in the first few days of life to high-risk premature infants. Hence, we need easy-to-use noninvasive tools for a standardized, precise, and reliable BPD assessment at a very early stage, to support clinical decision-making and to predict the response to treatment. In this non-systematic review, we present an overview of strategies for monitoring preterm infants with early and evolving BPD-PPRD, and we make some remarks on future prospects, with a focus on near-infrared spectroscopy (NIRS).
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Affiliation(s)
- Tommaso Zini
- Department of Medical and Surgical Sciences of Mothers, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Francesca Miselli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41121 Modena, Italy;
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46
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Wang X, Wang S, Chen M, Lv Y, Chen X, Yang C. The value of hematocrit for predicting bronchopulmonary dysplasia in very low birth weight preterm infants. Medicine (Baltimore) 2023; 102:e35056. [PMID: 37773858 PMCID: PMC10545317 DOI: 10.1097/md.0000000000035056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023] Open
Abstract
To determine hematocrit (HCT) and to identify independent risk factors for predicting bronchopulmonary dysplasia (BPD) in preterm infants with very low birth weight (VLBW) infants. This retrospective study included 296 premature infants with VLBW in the neonatal intensive care unit of the First Affiliated Hospital of the University of Science and Technology of China between January 2015 and December 2019. Maternal pregnant information and clinical information as well as hematological parameters of preterm babies were collected and compared. Then the maximum area under the curve of receiver operating characteristic curve was developed to estimate the predictive indicator in the blood. Finally, differential variables together with the predictive index were screened for multiple logistic regression analysis to determine independent prognostic factors for BPD. Infants were divided into a BPD group (134 cases) and a non-BPD group (162 cases). The area under the curve of HCT at postnatal 1 week was 0.737 with the sensitivity of 52.30 % and the specificity of 86.00%. Birth weight (BW) <1.12 kg, gestational age <28.4 weeks, newborn respiratory distress syndrome, mechanical ventilation ≥ 7 days, ventilation associated pneumonia, patent arterial duct, PaO2/FiO2 <300 mm Hg and HCT <0.455 at postnatal 1 week were risk factors for BPD of VLBW infants. HCT levels below 0.455 at 1 week after birth serve as a valuable indicator for the potential development of BPD.
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Affiliation(s)
- Xuesong Wang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Cheeloo College of Medicine, Shandong University, Shenzhen, China
| | - Shushu Wang
- Department of Neonatology, The First Affiliated Hospital of USTC, Hefei, China
| | - Mingwu Chen
- Department of Neonatology, The First Affiliated Hospital of USTC, Hefei, China
| | - Yong Lv
- Department of Neonatology, The First Affiliated Hospital of USTC, Hefei, China
| | - Xueyu Chen
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Cheeloo College of Medicine, Shandong University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology, Shenzhen Maternity and Child Healthcare Hospital, Cheeloo College of Medicine, Shandong University, Shenzhen, China
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Gu D, Zhang B, Li J, Li Y, Wang Z, Diao J. Diagnostic Value of Pulmonary Ultrasound and Arterial Blood Gas Analysis in Acute Patients with Severe Injuries Complicated by Respiratory Failure-A Retrospective Study. J Multidiscip Healthc 2023; 16:2707-2714. [PMID: 37727596 PMCID: PMC10505646 DOI: 10.2147/jmdh.s424667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023] Open
Abstract
Background To investigate the early application of pulmonary ultrasonography and arterial blood gas analysis in critical patients with severe multiple injuries exacerbated by respiratory failure. Patients and Methods The retrospective selection was performed on 81 patients admitted to our critical care unit between January 2020 and January 2021 with severe multiple injuries rendered worse by respiratory failure. Based on the different examination procedures, the patients were categorised into three groups (n=27): group A; diagnosed with pulmonary ultrasonography, group B; diagnosed with arterial blood gas; and group C; diagnosed with both pulmonary ultrasonography and arterial blood gas analyses. Patients were subsequently divided into a survival group (n = 65) and a death group (n = 16). On an annual basis, patients' prognoses were examined in relation to the predictive value of pulmonary ultrasound. Results Initial diagnosis, diagnosis, and initial correct treatment times were significantly shorter in groups B and C than group A (P<0.05). In contrast, initial diagnosis time, diagnosis time, and initial correct treatment times were potentially shorter in group C than in group B (P<0.05). Compared to groups B and C, group A had a considerably lower diagnosis rate for the examination methods (P<0.05). The right diaphragm displacement and left diaphragm displacement in the survival group were potentially higher than the LUS score (P < 0.05). In contrast, the survival group's lung ultrasound score (LUS) was considerably lower than the death group's. Statistical analysis showed that the predictive values of right diaphragm displacement, left diaphragm displacement, and mean diaphragm displacement were significant compared with the LUS score. The findings of the receiver operating characteristic curve demonstrated that the right, left, and average diaphragm displacements had high predictive values. Conclusion In the early evaluation of patients with severe multiple injuries complicated by respiratory failure, pulmonary ultrasonography combined with arterial blood gas analysis is crucial for the rapid diagnosis and prognosis prediction of patients.
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Affiliation(s)
- Dongming Gu
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Bo Zhang
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Jing Li
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Yanpeng Li
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Zhihua Wang
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
| | - Jianjun Diao
- Department of Emergency, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, People’s Republic of China
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48
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Shen J, Du Y, Sun Y, Huang X, Zhou J, Chen C. Modified lung ultrasound score for bronchopulmonary dysplasia predicts late respiratory outcomes in preterm infants. Pediatr Pulmonol 2023; 58:2551-2558. [PMID: 37294069 DOI: 10.1002/ppul.26546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Lung ultrasound (LUS) is a useful and radiation-free diagnostic tool for predicting bronchopulmonary dysplasia, which is a risk factor for late respiratory disease. However, data on the relationship of LUS with late respiratory disease was scarce. This study aims to determine whether LUS is associated with late respiratory disease during early childhood. METHODS This prospective cohort study enrolled preterm infants born before 32 weeks of gestation. LUS was performed at 36 weeks' postmenstrual age. The predictive values of a modified lung ultrasound (mLUS) score based on eight standard sections were assessed to predict late respiratory disease, defined as a physician diagnosis of bronchopulmonary dysplasia deterioration, asthma, reactive airway disease, bronchiolitis, pneumonia, or respiratory-related hospitalization during the first 2 years of life. RESULTS A total of 94 infants completed follow-up, of whom 74.5% met the late respiratory disease criteria. The mLUS scores were significantly associated with late respiratory disease (adjusted odds ratio: 1.23, CI: 1.10-1.38, p < 0.001). The mLUS scores also well predicted late respiratory disease (AUC = 0.820, 95% CI: 0.733-0.907). These scores were superior to the classic lung ultrasound score (p = 0.02) and as accurate as the modified NICHD-defined bronchopulmonary dysplasia classification (p = 0.91). A mLUS score ≥14 was the optimal cutoff point for predicting late respiratory disease. CONCLUSION The modified lung ultrasound score correlates significantly with late respiratory disease and well predicts it in preterm infants during the first 2 years of life.
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Affiliation(s)
- Jieru Shen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yang Du
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yinghua Sun
- Department of Ultrasound, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiangyuan Huang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jianguo Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
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DeBoer EM, Morgan WJ, Quiros-Alcala L, Rosenfeld M, Stout JW, Davis SD, Gaffin JM. Defining and Promoting Pediatric Pulmonary Health: Assessing Lung Function and Structure. Pediatrics 2023; 152:e2023062292E. [PMID: 37656029 PMCID: PMC10484309 DOI: 10.1542/peds.2023-062292e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 09/02/2023] Open
Abstract
Lifelong respiratory health is rooted in the structural and functional development of the respiratory system in early life. Exposures and interventions antenatally through childhood can influence lung development into young adulthood, the life stage with the highest achievable lung function. Because early respiratory health sets the stage for adult lung function trajectories and risk of developing chronic obstructive pulmonary disease, understanding how to promote lung health in children will have far reaching personal and population benefits. To achieve this, it is critical to have accurate and precise measures of structural and functional lung development that track throughout life stages. From this foundation, evaluation of environmental, genetic, metabolic, and immune mechanisms involved in healthy lung development can be investigated. These goals require the involvement of general pediatricians, pediatric subspecialists, patients, and researchers to design and implement studies that are broadly generalizable and applicable to otherwise healthy and chronic disease populations. This National Institutes of Health workshop report details the key gaps and opportunities regarding lung function and structure.
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Affiliation(s)
- Emily M. DeBoer
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wayne J. Morgan
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Lesliam Quiros-Alcala
- Johns Hopkins University, Bloomberg School of Public Health and Whiting School of Engineering, Environmental Health and Engineering, Baltimore, Maryland
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - James W. Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Stephanie D. Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jonathan M. Gaffin
- Division of Pulmonary Medicine, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Zong H, Huang Y, Huang Z, Zhao J, Lin B, Fu Y, Lin Y, Yu Y, Sun H, Yang C. Lung ultrasound score predicts patent ductus arteriosus ligation among neonates ≤25 weeks. Pediatr Pulmonol 2023; 58:2487-2494. [PMID: 37265422 DOI: 10.1002/ppul.26531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 02/27/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND This prospective study aimed to investigate whether lung ultrasound score (LUSs) can predict the patent ductus arteriosus (PDA) ligation. METHODS Preterm infants ≤25 weeks of gestational age (GA) were enrolled. A lung ultrasound was performed on the 14th day of life. Each lung zone was given a score between 0 and 4. A receiver-operating characteristic (ROC) curve was constructed to evaluate the ability of the LUSs for predicting ligation. RESULTS A total of 81 infants were eligible with a median GA and birth weight (BW) of 25 weeks (24.1-25.2) and 710 g (645-770), respectively. The median time from birth to ligation was 35 days (32-51). Those who underwent ligation had a longer time of mechanical ventilation (34 [26-39] vs. 19 [12-30], p < 0.001), shorter time of noninvasive respiratory support (39 [32-51] vs. 50 [41.5-57], p < 0.01), higher incidence of the bronchopulmonary dysplasia (BPD) (p < 0.01), and severe BPD (p < 0.001). The LUSs had an area under the ROC of 0.96 (95% confidence interval: 0.93-0.99) for the prediction of ligation. A LUSs cutoff of 36 has a sensitivity and specificity of 96% and 86% and positive and negative predictive values of 82% and 98%, respectively. CONCLUSIONS LUSs at an early stage of life can predict PDA ligation in extremely preterm infants. It would be helpful to reduce morbidity by reducing the duration and magnitude of respiratory support.
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Affiliation(s)
- Haifeng Zong
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yichu Huang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Zhifeng Huang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Jie Zhao
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Bingchun Lin
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yongping Fu
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanqing Lin
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Yanliang Yu
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Hongyan Sun
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Chuanzhong Yang
- Department of Neonatology and NICU, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China
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