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DOI: 10.1055/s-0043-1775975
Prognostic Relevance of the Lung Ultrasound Score: A Multioutcome Study in Infants with Respiratory Distress Syndrome
Authors
Funding The study was financially supported by Chiesi Poland Sp. Z O.O., a subsidiary of Chiesi Farmaceutici, Italy.

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
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Lung ultrasound has significant prognostic abilities in neonatal RDS.
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Early sonograms (0–6 h of life) accurately predict the requirement for SF and ventilation.
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Weaning off CPAP is effective when the LUS (range 0–16) is less than or equal to 1.
Keywords
lung ultrasound - neonate - preterm - respiratory distress syndrome - surfactant - ventilationEthics Approval and Consent to Participate
Detailed information about the aim and course of the study was given to all parents or legal guardians of the participating infants, and written informed consent was obtained. All procedures were performed in compliance with the ethical principles laid forth in the Helsinki Declaration of 1964 and its subsequent amendments. The study protocol was approved by the Ethics Committee of Warsaw Medical University (ref. no. KB/47/2021), in accordance with the principal investigator's affiliation.
Authors' Contributions
P.S., R.H., R.B., P.K., I.S-K., and W.B. were involved in planning and supervision of the study. R.H., P.K., M.S., and I.S-K. drafted the manuscript with input from all authors. R.H. designed the figures. P.K. compiled the literature sources and provided critical feedback. R.B., J.P-G., U.M., A.T., M.K-M., N.S-W., and P.S. performed ultrasound examinations. All authors discussed the results and approved the version to be published.
Publikationsverlauf
Eingereicht: 02. Mai 2023
Angenommen: 21. August 2023
Artikel online veröffentlicht:
17. Oktober 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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