Lung Ultrasound Score Progress in Neonatal Respiratory Distress Syndrome

Francesco Raimondi, Fiorella Migliaro, Iuri Corsini, Fabio Meneghin, Pasquale Dolce, Luca Pierri, Alessandro Perri, Salvatore Aversa, Stefano Nobile, Silvia Lama, Silvia Varano, Marilena Savoia, Sara Gatto, Valentina Leonardi, Letizia Capasso, Virgilio Paolo Carnielli, Fabio Mosca, Carlo Dani, Giovanni Vento, Gianluca Lista
Pediatrics 2021, 147 (4)

BACKGROUND AND OBJECTIVES: The utility of a lung ultrasound score (LUS) has been described in the early phases of neonatal respiratory distress syndrome (RDS). We investigated lung ultrasound as a tool to monitor respiratory status in preterm neonates throughout the course of RDS.

METHODS: Preterm neonates, stratified in 3 gestational age cohorts (25-27, 28-30, and 31-33 weeks), underwent lung ultrasound at weekly intervals from birth. Clinical data, respiratory support variables, and major complications (sepsis, patent ductus arteriosus, pneumothorax, and persistent pulmonary hypertension of the neonate) were also recorded.

RESULTS: We enrolled 240 infants in total. The 3 gestational age intervals had significantly different LUS patterns. There was a significant correlation between LUS and the ratio of oxygen saturation to inspired oxygen throughout the admission, increasing with gestational age (b = -0.002 [ P < .001] at 25-27 weeks; b = -0.006 [ P < .001] at 28-30 weeks; b = -0.012 [ P < .001] at 31-33 weeks). Infants with complications had a higher LUS already at birth (12 interquartile range 13-8 vs 8 interquartile range 12-4 control group; P = .001). In infants 25 to 30 weeks' gestation, the LUS at 7 days of life predicted bronchopulmonary dysplasia with an area under the curve of 0.82 (95% confidence interval 0.71 to 93).

CONCLUSIONS: In preterm neonates affected by RDS, the LUS trajectory is gestational age dependent, significantly correlates with the oxygenation status, and predicts bronchopulmonary dysplasia. In this population, LUS is a useful, bedside, noninvasive tool to monitor the respiratory status.

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