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Silveira Neves G, Silveira Nogueira Reis Z, Maia de Castro Romanelli R, dos Santos Nascimento J, Dias Sanglard A, Batchelor J. The role of chest X-ray in the diagnosis of neonatal respiratory distress syndrome: a systematic review concerning low-resource birth scenarios. Glob Health Action 2024; 17:2338633. [PMID: 38660779 PMCID: PMC11047214 DOI: 10.1080/16549716.2024.2338633] [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: 10/29/2023] [Accepted: 03/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Access to diagnostic tools like chest radiography (CXR) is challenging in resource-limited areas. Despite reduced reliance on CXR due to the need for quick clinical decisions, its usage remains prevalent in the approach to neonatal respiratory distress syndrome (NRDS). OBJECTIVES To assess CXR's role in diagnosing and grading NRDS severity compared to current clinical features and laboratory standards. METHODS A review of studies with NRDS diagnostic criteria was conducted across six databases (MEDLINE, EMBASE, BVS, Scopus-Elsevier, Web of Science, Cochrane) up to 3 March 2023. Independent reviewers selected studies, with discrepancies resolved by a senior reviewer. Data were organised into descriptive tables to highlight the use of CXR and clinical indicators of NRDS. RESULTS Out of 1,686 studies screened, 23 were selected, involving a total of 2,245 newborns. All selected studies used CXR to diagnose NRDS, and 21 (91%) applied it to assess disease severity. While seven reports (30%) indicated that CXR is irreplaceable by other diagnostic tools for NRDS diagnosis, 10 studies (43%) found that alternative methods surpassed CXR in several respects, such as severity assessment, monitoring progress, predicting the need for surfactant therapy, foreseeing Continuous Positive Airway Pressure failure, anticipating intubation requirements, and aiding in differential diagnosis. CONCLUSION CXR remains an important diagnostic tool for NRDS. Despite its continued use in scientific reports, the findings suggest that the study's outcomes may not fully reflect the current global clinical practices, especially in low-resource settings where the early NRDS approach remains a challenge for neonatal survival.Trial registration: PROSPERO number CRD42022336480.
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Affiliation(s)
- Gabriela Silveira Neves
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | - Zilma Silveira Nogueira Reis
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | - Roberta Maia de Castro Romanelli
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | | | - André Dias Sanglard
- Postgraduate Program in Health Sciences: Child and Adolescent Health – PPGSCA, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Brazil
| | - James Batchelor
- Clinical Informatics and Healthcare Innovation, Faculty of Medicine, University of Southampton, Southampton, UK
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Kelner J, Moote D, Shah R, Anuar A, Golioto A. Lung Ultrasound Score for Prediction of Surfactant Administration in Preterm Infants with Respiratory Failure. J Perinatol 2024; 44:1258-1263. [PMID: 39122885 DOI: 10.1038/s41372-024-02090-3] [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: 02/06/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE We investigated the predictive value of a lung ultrasound score (LUS) for surfactant administration in a United States Level 4 Neonatal Intensive Care Unit. STUDY DESIGN Thirty infants born at <37 weeks gestational age with respiratory distress syndrome associated respiratory failure requiring continuous positive airway pressure were included. A LUS was obtained within six hours of life. Surfactant administration in the first five days of life was recorded. Receiver operating characteristic (ROC) analysis for LUS and surfactant administration was performed. RESULTS Median completed gestational age was 33 weeks (31-34 weeks interquartile range) and median birth weight was 2.0 kg (1.5-2.3 kg). LUS for predicting an initial surfactant dose had an area under the ROC curve of 0.97. A score > 9 provided 100% sensitivity and 91% specificity for predicting administration of an initial surfactant dose. CONCLUSION A LUS > 9 provided excellent sensitivity and specificity for predicting which infants will receive surfactant for associated respiratory failure.
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Affiliation(s)
- Jacob Kelner
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA.
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA.
| | - Douglas Moote
- Division of Pediatric Radiology, Connecticut Children's, Hartford, CT, USA
| | - Rahul Shah
- Division of Pediatric Emergency Medicine, Connecticut Children's, Hartford, CT, USA
| | - Amirul Anuar
- Health Services Research Institute, Connecticut Children's, Hartford, CT, USA
| | - Annmarie Golioto
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA
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Alsina-Casanova M, Brito N, Balcells-Esponera C, Herranz-Barbero A, Teresa-Palacio M, Soler-García A, Agustí C, Brullas G, Clotet J, Carrasco C, Salvia D, Aldecoa-Bilbao V. Predictors of CPAP failure after less-invasive surfactant administration in preterm infants. Front Pediatr 2024; 12:1444906. [PMID: 39258148 PMCID: PMC11383777 DOI: 10.3389/fped.2024.1444906] [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: 06/06/2024] [Accepted: 08/05/2024] [Indexed: 09/12/2024] Open
Abstract
Introduction Less-invasive surfactant administration (LISA) is associated with better respiratory outcomes in preterm infants with respiratory distress syndrome. However, mechanical ventilation (MV) shortly after the LISA procedure has been related to lower survival. This study aimed to analyze the trends and main predictors of continuous positive airway pressure (CPAP) failure after LISA. Material and methods Preterm infants born between 230 and 336 weeks gestational age (GA) in two level III neonatal units who received surfactant were included (2017-2022). Demographic data, lung ultrasound (LUS) scores, the saturation/fraction of inspired oxygen (SF) ratio, technique, time to surfactant administration, and the main neonatal outcomes were collected. Results Over the study period, 289 inborn preterm infants received surfactant, 174 with the LISA method (60.2%). Patients who received surfactant after intubation in the delivery room (n = 56) were more immature and exhibited worse outcomes. Patients who received surfactant via an endotracheal tube in the neonatal intensive care unit (n = 59) had higher LUS scores and a lower SF ratio than those treated with LISA. The LISA method was associated with less death or bronchopulmonary dysplasia (BPD), with an adjusted odds ratio (aOR) = 0.37 [95% confidence interval (CI), 0.18-0.74, p = 0.006]. CPAP failure after LISA (defined as the need for intubation and MV in the first 72 h of life) occurred in 38 patients (21.8%), inversely proportional to GA (38.7% at 23-26 weeks, 26.3% at 27-30 weeks, and 7.9% at 30-33 weeks (p < 0.001). CPAP failure after LISA was significantly related to death, with an aOR = 12.0 (95% CI, 3.0-47.8, p < 0.001), and moderate to severe BPD, with an aOR = 2.9 (95% CI, 1.1-8.0, p = 0.035), when adjusting for GA. The best predictors of CPAP failure after LISA were GA, intrauterine growth restriction, temperature at admission, the SF ratio, and the LUS score, with a Nagelkerke's R 2 = 0.458 (p < 0.001). The predictive model showed an area under the curve = 0.84 (95% CI, 0.75-0.93, p < 0.001). Conclusions CPAP failure after LISA is still common in extremely preterm infants, leading to an increase in death or disability. Clinicians must acknowledge the main risk factors of CPAP failure to choose wisely the right patient and the best technique. LUS and the SF ratio at admission can be useful when making these decisions.
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Affiliation(s)
- Miguel Alsina-Casanova
- Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Nerea Brito
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Carla Balcells-Esponera
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Ana Herranz-Barbero
- Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Marta Teresa-Palacio
- Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | | | - Carmen Agustí
- Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Guillem Brullas
- Pediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jordi Clotet
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Cristina Carrasco
- Neonatology Department, Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Dolors Salvia
- Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatology Department, Hospital Clínic Barcelona, BCNatal (Barcelona Center for Maternal-Fetal and Neonatal Medicine), Barcelona, Spain
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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: 6] [Impact Index Per Article: 6.0] [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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Hu L, Zhu S. A Retrospective Analysis of Ultrasonic Diagnosis of Neonatal Respiratory Distress Syndrome. Ultrasound Q 2023; 39:212-215. [PMID: 37756247 DOI: 10.1097/ruq.0000000000000652] [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: 09/29/2023]
Abstract
ABSTRACT The aim of the study was to investigate ultrasound's diagnostic capabilities for infant respiratory distress syndrome. Retrospective analysis was performed on the clinical information of 96 newborns with respiratory distress syndrome who were treated at our hospital between July 2015 and October 2017. The patients were split into the mild group (n = 55) and the severe group based on the findings of the chest x-ray examinations (n = 41). All neonates underwent an ultrasound examination at baseline, 12 hours after treatment and 24 hours after treatment of pulmonary surfactant (PS). Between the 2 groups, ultrasonographic characteristics and imaging scores were compared between infants with and without PS treatment. When compared with the severe group, the ultrasound score in the mild group was lower ( P < 0.05). Before treatment, there was no statistically significant difference in ultrasound score between the PS treatment group and the non-PS treatment group ( P > 0.05). At each time point after treatment, the ultrasonography score of the non-PS treatment group was greater than that of the PS treatment group ( P < 0.05). Neonatal respiratory distress syndrome severity may be accurately assessed using ultrasound technology. Furthermore, the results of ultrasonography examinations may serve as a significant marker for assessing and measuring the severity of newborn respiratory distress syndrome.
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Affiliation(s)
- Ling Hu
- Department of ultrasound medicine, Xuzhou Central Hospital, Xuzhou, China
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De Luca D, Loi B, Tingay D, Fiori H, Kingma P, Dellacà R, Autilio C. Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction. Semin Fetal Neonatal Med 2023; 28:101494. [PMID: 38016825 DOI: 10.1016/j.siny.2023.101494] [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: 11/30/2023]
Abstract
Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France; Department of Pediatrics, Division of Neonatology, Stanford University, School of Medicine - Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France
| | - David Tingay
- Neonatal Research Unit, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Humberto Fiori
- Division of Neonatology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paul Kingma
- Perinatal Institute, Cincinnati Children's University Hospital Medical Center, Cincinnati, OH, USA
| | - Raffaele Dellacà
- Department of Electronics, Information and Bio-engineering, Polytechnical University of Milan, Milan, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology and Research Institute Hospital October 12 (imas12), Faculty of Biology, Complutense University, Madrid, Spain; Clinical Pathology and Microbiology Unit, San Carlo Hospital, Potenza, Italy
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Raimondi F, Dolce P, Veropalumbo C, Sierchio E, Gregorio Hernandez R, Rodriguez Fanjul J, Meneghin F, Raschetti R, Bonadies L, Corsini I, Alonso Ojembarrena A, Salomè S, Rodeño Fernandez L, Sanchez Luna M, Lista G, Mosca F, Dani C, Baraldi E, Giordano L, Davis PG, Capasso L. External Validation of a Multivariate Model for Targeted Surfactant Replacement. Neonatology 2023; 121:17-24. [PMID: 37883936 DOI: 10.1159/000532083] [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: 03/21/2023] [Accepted: 07/11/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Early targeted surfactant therapy for preterm infants is recommended but the best criteria to personalize treatment are unclear. We validate a previously published multivariate prognostic model based on gestational age (GA), lung ultrasound score (LUS), and oxygen saturation to inspire oxygen fraction ratio (SatO2/FiO2) using an independent data set. METHODS Pragmatic, observational study in 10 Italian and Spanish NICUs, including preterm babies (250 and 336 weeks divided into 3 GA intervals) with clinical signs of respiratory distress syndrome and stabilized on CPAP. LUS and SatO2/FiO2 were collected soon after stabilization. Their prognostic accuracy was evaluated on the subsequent surfactant administration by a rigorously masked physician. RESULTS One hundred seventy-five infants were included in the study. Surfactant was given to 74% infants born at 25-27 weeks, 38.5% at 28-30 weeks, and 26.5% at 31-33 weeks. The calibration curve comparing the validation and the development populations showed significant overlap with an intercept = 0.08, 95% CI (-0.34; 0.5) and a slope = 1.53, 95% CI (1.07-1.98). The validation cohort had a high predictive accuracy. Its ROC curve showed an AUC = 0.95, 95% CI (0.91-0.99) with sensitivity = 0.93, 95% CI (0.83-0.98), specificity = 0.81, 95% CI (0.73-0.88), PPV = 0.76, 95% CI (0.65-0.84), NPV = 0.95, 95% CI (0.88-0.98). LUS ≥9 demonstrated the highest sensitivity (0.91, 95% CI [0.82-0.97]) and specificity = 0.81, 95% CI (0.72-0.88) as individual predictor. LUS and SatO2/FiO2 prognostic performances varied with GA. CONCLUSION We validated a prognostic model based on LUS and Sat/FiO2 to facilitate early, customized surfactant administration that may improve respiratory management of preterm neonates.
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Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Naples, Italy
| | - Pasquale Dolce
- Department of Public Health, Università Federico II di Napoli, Naples, Italy
| | - Claudio Veropalumbo
- Division of Neonatology, Department of Translational Medical Sciences, Naples, Italy
| | | | - Rebeca Gregorio Hernandez
- Neonatology Division, Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | - Javier Rodriguez Fanjul
- Neonatal Intensive Care Unit, Department of Paediatrics, Hospital Germans Triasi Pujol, Autonomous University of Barcelona, Badalona, Spain
| | | | - Roberto Raschetti
- Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luca Bonadies
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | | | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, Naples, Italy
| | | | - Manuel Sanchez Luna
- Neonatology Division, Instituto de Investigación Sanitaria Hospital General Universitario Gregorio Marañón, Complutense University of Madrid, Madrid, Spain
| | | | - Fabio Mosca
- Department of Clinical Sciences and Community Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Eugenio Baraldi
- Women's and Children's Health Department, University of Padova, Padova, Italy
| | | | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Naples, Italy
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Luo K, Wang H, Huang F, Tang J. Optimal timing and cutoff range of lung ultrasound in predicting surfactant administration in neonates: A meta-analysis and systematic review. PLoS One 2023; 18:e0287758. [PMID: 37498845 PMCID: PMC10374100 DOI: 10.1371/journal.pone.0287758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/11/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Timely application of surfactant replacement therapy is critical for neonates with respiratory distress syndrome (RDS). Presently, early clinical decision on surfactant use relies solely on ventilator parameters. However, ventilator parameters are unable to truly recapitulate the extent of surfactant deficiency. Lung ultrasound has been increasingly used in the early prediction of surfactant use in recent years, but its predictive value remains unclear. Therefore, we conducted this study to examine its predictive value in surfactant use and determine the optimal timing and cutoff value. METHODS Studies on neonates with respiratory distress or diagnosed with RDS were collected from PubMed, Embase, Cochrane Library, and Web of Science. Primary outcomes included sensitivity, specificity, and positive and negative predictive values of lung ultrasound. RESULTS Ten eligible studies with 1162 participants were included. The sensitivity and specificity of lung ultrasound in predicting surfactant use were 0.86 (95% CI: 0.81-0.90) and 0.82 (95% CI: 0.71-0.90), respectively. Lung ultrasound performed within 1-3 h after birth had a sensitivity of 0.89 (95% CI: 0.79-0.95) and a Youden's index of 0.67. Compared with a lung ultrasound score (LUS) cutoff of ≤6/7, ≤8, >5, >6/7, and >8, a LUS cutoff of ≤5 had higher Youden's index (0.73) and sensitivity (0.94, 95% CI: 0.85-0.97) in predicting surfactant use. CONCLUSIONS Lung ultrasound is effective for predicting surfactant use in neonates. Lung ultrasound within 1-3 h after birth and a LUS cutoff of 5 are recommended. However, the symptoms and oxygenation of the neonatal patients must also be considered.
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Affiliation(s)
- Keren Luo
- Department of Neonatology, West China Second Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu City, Sichuan Province, China
| | - Haoran Wang
- West China School of Medicine, Sichuan University, Chengdu City, Sichuan Province, China
| | - Fangjun Huang
- West China School of Medicine, Sichuan University, Chengdu City, Sichuan Province, China
| | - Jun Tang
- Department of Neonatology, West China Second Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu City, Sichuan Province, China
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Capasso L, Pacella D, Migliaro F, Salomè S, Grasso F, Corsini I, De Luca D, Davis PG, Raimondi F. Can lung ultrasound score accurately predict surfactant replacement? A systematic review and meta-analysis of diagnostic test studies. Pediatr Pulmonol 2023; 58:1427-1437. [PMID: 36717970 DOI: 10.1002/ppul.26337] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/30/2022] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical and radiographic criteria are traditionally used to determine the need for surfactant therapy in preterm infants. Lung ultrasound is a bedside test that offers a rapid, radiation-free, alternative to this approach. OBJECTIVE To conduct a systematic review and meta-analysis to determine the accuracy of a lung ultrasound score (LUS) in identifying infants who would receive at least one surfactant dose. Secondary aims were to evaluate the predictive accuracy for ≥2 doses and the accuracy of a different image classification system based on three lung ultrasound profiles. METHODS PubMed, SCOPUS, Biomed Central, and the Cochrane library between January 2011 and December 2021 were searched. Full articles enrolling preterm neonates who underwent lung ultrasound to predict surfactant administration were assessed and analyzed following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and QUADAS-2 guidelines. RESULTS Seven prospective studies recruiting 697 infants met the inclusion criteria. Risk of bias was generally low. Oxygen requirement, clinical and radiographic signs of respiratory distress syndrome were used as reference standards for surfactant replacement. The summary receiver operator characteristic (sROC) curve for LUS predicting first surfactant dose showed an area under the curve (AUC) = 0.88 (95% confidence interval [CI]: 0.82-0.91); optimal specificity and sensitivity (Youden index) were 0.83 and 0.81 respectively. Pooled estimates of sensitivity, specificity, diagnostic odds ratio, negative predictive value, and positive predictive value for LUS predicting the first surfactant dose were 0.89 (0.82-0.95), 0.86 (0.78-0.95), 3.78 (3.05-4.50), 0.92 (0.87-0.97), 0.79 (0.65-0.92). The sROC curve for the accuracy of Type 1 lung profile in predicting first surfactant dose showed an AUC of 0.88; optimal specificity and sensitivity were both 0.86. Two studies addressing the predictive accuracy of LUS for ≥2 surfactant doses had high heterogeneity and were unsuitable to combine in a meta-analysis. DISCUSSION Despite current significant variation in LUS thresholds, lung ultrasound is highly predictive of the need for early surfactant replacement. This evidence was derived from studies with homogeneous patient characteristics and low risk of bias.
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Affiliation(s)
- Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, Università Federico II di Napoli, Naples, Italy
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Fiorentino Grasso
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
| | - Iuri Corsini
- Careggi Hospital, Università di Firenze, Florence, Italy
| | - Daniele De Luca
- Service de Pediatrie et Reanimation Neonatale Hopital "A. Beclere"-Paris Saclay University Hospitals, APHP, Paris, France
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy
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10
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Mohsen N, Nasef N, Ghanem M, Yeung T, Deekonda V, Ma C, Kajal D, Baczynski M, Jain A, Mohamed A. Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study. Pediatr Pulmonol 2023; 58:530-539. [PMID: 36324211 DOI: 10.1002/ppul.26223] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chest ultrasound has emerged as a promising tool in predicting extubation readiness in adults and children, yet its utility in preterm infants is lacking. Our aim was to assess the utility of lung ultrasound severity score (LUSS) and diaphragmatic function in predicting extubation readiness in extremely preterm infants. STUDY DESIGN In this prospective cohort study, preterm infants < 28 weeks gestational age (GA) who received invasive mechanical ventilation for ≥12 h were enrolled. Chest ultrasound was performed before extubation. The primary outcome was lung ultrasound accuracy for predicting successful extubation at 3 days. Descriptive statistics and logistic regression were done using SPSS version 22. RESULTS We enrolled 45 infants, of whom 36 (80%) were successfully extubated. GA and postmenstrual age (PMA) at extubation were significantly higher in the successful group. The LUSS was significantly lower in the successful group compared to failed group (11.9 ± 3.2 vs. 19.1 ± 3.1 p < 0.001). The two groups had no statistically significant difference in diaphragmatic excursion or diaphragmatic thickness fraction. Logistic regression analysis controlling for GA and PMA at extubation showed LUSS was an independent predictor for successful extubation (odd ratio 0.46, 95% confidence interval [0.23-0.9], p = 0.02). The area under the receiver operating characteristic curve was 0.95 (p ˂ 0.001) for LUSS, and a cut-off value of ≥15 had 95% sensitivity and 85% specificity in detecting extubation failure. CONCLUSION In extremely preterm infants, lung ultrasound has good accuracy for predicting successful extubation. However, diaphragmatic measurements were not reliable predictors.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Telford Yeung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Windsor Regional Hospital Metropolitan campus, Windsor, Ontario, Canada
| | | | - Carmen Ma
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dilkash Kajal
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
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11
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Corrigendum to Non-invasive ventilation and exogenous surfactant in times of ever decreasing gestational age: How do we make the most of these tools? The Journal of Pediatrics 247(2022):138-146. J Pediatr 2023; 255:264. [PMID: 36599711 DOI: 10.1016/j.jpeds.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Rodriguez-Fanjul J, Corsini I, Ortí CS, Bobillo-Perez S, Raimondi F. Lung ultrasound to evaluate lung recruitment in neonates with respiratory distress (RELUS study). Pediatr Pulmonol 2022; 57:2502-2510. [PMID: 35792663 DOI: 10.1002/ppul.26066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is a bedside tool useful to diagnose neonatal respiratory disease and to guide surfactant therapy. LUS scores have emerged as useful tool for newborn respiratory distress but is unknown if respiratory support settings may influence it. The aim of the study was to evaluate the feasibility of LUS scores evaluating lung recruitment in term newborns with respiratory distress when noninvasive respiratory it is increased. MATERIAL AND METHODS Prospective study in a tertiary neonatal intensive care unit. Inclusion criteria were term neonates with respiratory distress requiring noninvasive respiratory support with nasal continuous positive airway pressure (nCPAP) within first 6 h of life with an LUS score higher than 8 were enrolled. LUS was performed three times. First LUS (LUS-1) was done in patients in nCPAP (Fabian Device) (Acutronic) (pressure of 6 cmH2 O). Afterwards patients were placed in duo positive airway pressure (12/6 cmH2 O), a second LUS (LUS-2) was performed immediately and a third (LUS-3) was done 2 h later on the same respiratory support. The primary outcome was to compare LUS scores in the different timelines. Second outcomes were to evaluate the level of respiratory distress and oxygenation were evaluated with SpO2 /fraction of inspired oxygen (FiO2 ) ratio (S/F ratio), FiO2 ratio, respiratory rate, and blood gas analysis which were analyzed during the LUS-1 and the LUS-3. To evaluate newborn discomfort, patients were evaluated with Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale. RESULTS Forty neonates were enrolled. Fifty percent were female (n = 20), median gestational age was 38 + 4 (interquartile range [IQR]: 37 + 5-39 + 4) with a median weight of 3155 g (IQR: 2637-3532). Duration of non invasive ventilation support was 72 h (IQR: 54-96). None of the patients required surfactant therapy or mechanical ventilation. LUS scores were no different between LUS-1 9 (IQR: 8.3-10) and LUS-2 9 (IQR: 8.3-10) (p = 0.675) but there were differences between LUS-1 and LUS-3 7 (IQR: 6.3-8.5) (p = 0.036). There was an improvement in the oxygen parameters, respiratory rate, and CO2 between LUS-1 and LUS-3 (p < 0.001). There were no changes in the CRIES scale. CONCLUSIONS There is an improvement in clinical and laboratory parameters after the increasing of respiratory support in newborns with noninvasive ventilation. We observe a correlation with an improvement in the assessment of lung aeration were evaluated with LUS score.
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Affiliation(s)
- Javier Rodriguez-Fanjul
- Neonatal Intensive Care Unit, Paediatric Department, Hospital Germans Trias i Pujol, Badalona, Spain.,Institut d'Investigació Germans Trias I Pujol, Badalona, Spain
| | - Iuri Corsini
- Neonatology Division, Careggi University Hospital of Florence, Florence, Italy
| | - Clara Sorribes Ortí
- Neonatal Intensive Care Unit, Paediatric Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Sara Bobillo-Perez
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.,Immunological and Respiratory Disorders in the Paediatric Critical Care Patient Research Group, Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Francesco Raimondi
- Department of Translational Medical Sciences, Neonatology Division, Università "Federico II", Napoli, Italy
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13
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Utilidad de la ecografía pulmonar en el diagnóstico y seguimiento de la patología respiratoria neonatal. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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14
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Fernández LR, Hernández RG, Guerediaga IS, Gato JM, Fanjul JR, Bilbao VA, Quintela PA, Ojembarrena AA. Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates. An Pediatr (Barc) 2022; 96:252.e1-252.e13. [DOI: 10.1016/j.anpede.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
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15
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Guo BB, Pang L, Yang B, Zhang C, Chen XY, OuYang JB, Wu CJ. Lung Ultrasound for the Diagnosis and Management of Neonatal Respiratory Distress Syndrome: A Minireview. Front Pediatr 2022; 10:864911. [PMID: 35498779 PMCID: PMC9047941 DOI: 10.3389/fped.2022.864911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Lung ultrasound (LUS) is useful for diagnosis of respiratory distress syndrome in neonates. Recently, it has been proved to play an important role in the management of neonatal respiratory distress syndrome (RDS). It is feasible to grade RDS and select therapeutic modalities accordingly by LUS. The treatment also should be adjusted with the change in ultrasound images. In conclusion, LUS is valuable for the diagnosis and management of neonatal respiratory distress syndrome.
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Affiliation(s)
- Bin-Bin Guo
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Pang
- Department of Ultrasound, Harbin Finance University, Harbin, China
| | - Bo Yang
- Department of Ultrasound, Taian Maternal and Child Health Hospital of Shandong Province, Taian, China
| | - Cong Zhang
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Ya Chen
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jia-Bao OuYang
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chang-Jun Wu
- Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin, China
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16
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Wang J, Wei H, Chen H, Wan K, Mao R, Xiao P, Chang X. Application of ultrasonography in neonatal lung disease: An updated review. Front Pediatr 2022; 10:1020437. [PMID: 36389379 PMCID: PMC9640768 DOI: 10.3389/fped.2022.1020437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
Lung disease is often life-threatening for both preterm and term newborns. Therefore, an accurate and rapid diagnosis of lung diseases in newborns is crucial, as management strategies differ with different etiologies. To reduce the risk of radiation exposure derived from the conventionally used chest x-ray as well as computed tomography scans, lung ultrasonography (LUS) has been introduced in clinical practice to identify and differentiate neonatal lung diseases because of its radiation-free characteristic, convenience, high accuracy, and low cost. In recent years, it has been proved that LUS exhibits high sensitivity and specificity for identifying various neonatal lung diseases. Here, we offer an updated review of the applications of LUS in neonatal lung diseases based on the reports published in recent years (2017 to present).
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Affiliation(s)
- Jin Wang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hongjuan Wei
- Department of Neonatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Hui Chen
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Ke Wan
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ruifeng Mao
- School of Life Sciences, Huaiyin Normal University, Huai'an, China
| | - Peng Xiao
- Department of Dermatology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
| | - Xin Chang
- Department of Ultrasound Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
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17
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Raimondi F, Migliaro F, Corsini I, Meneghin F, Pierri L, Salomè S, Perri A, Aversa S, Nobile S, Lama S, Varano S, Savoia M, Gatto S, Leonardi V, Capasso L, Carnielli VP, Mosca F, Dani C, Vento G, Dolce P, Lista G. Neonatal Lung Ultrasound and Surfactant Administration: A Pragmatic, Multicenter Study. Chest 2021; 160:2178-2186. [PMID: 34293317 DOI: 10.1016/j.chest.2021.06.076] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous research shows that a lung ultrasound score (LUS) can anticipate CPAP failure in neonatal respiratory distress syndrome. RESEARCH QUESTION Can LUS also predict the need for surfactant replacement? STUDY DESIGN AND METHODS Multicenter, pragmatic study of preterm neonates who underwent lung ultrasound at birth and those given surfactant by masked physicians, who also were scanned within 24 h from administration. Clinical data and respiratory support variables were recorded. Accuracy of LUS, oxygen saturation to Fio2 ratio, Fio2, and Silverman score for surfactant administration were evaluated using receiver operating characteristic curves. The simultaneous prognostic values of LUS and oxygen saturation to Fio2 ratio for surfactant administration, adjusting for gestational age (GA), were analyzed through a logistic regression model. RESULTS Two hundred forty infants were enrolled. One hundred eight received at least one dose of surfactant. LUS predicted the first surfactant administration with an area under the receiver operating characteristic curve (AUC) of 0.86 (95% CI, 0.81-0.91), cut off of 9, sensitivity of 0.79 (95% CI, 0.70-0.86), specificity of 0.83 (95% CI, 0.76-0.89), positive predictive value of 0.79 (95% CI, 0.71-0.87), negative predictive value of 0.82 (95% CI, 0.75-0.89), positive likelihood ratio of 4.65 (95% CI, 3.14-6.89), and negative likelihood ratio of 0.26 (95% CI, 0.18-0.37). No significant difference was shown among different GA groups: 25 to 27 weeks' GA (AUC, 0.91; 95% CI, 0.84-0.99), 28 to 30 weeks' GA (AUC, 0.81; 95% CI, 0.72-0.91), and 31 to 33 weeks' GA (AUC, 0.88; 95% CI, 0.79-0.95), respectively. LUS declined significantly within 24 h in infants receiving one surfactant dose. When comparing Fio2, oxygen saturation to Fio2 ratio, LUS, and Silverman scores as criteria for surfactant administration, only the latter showed a significantly poorer performance. The combination of oxygen saturation to Fio2 ratio and LUS showed the highest predictive power, with an AUC of 0.93 (95% CI, 0.89-0.97), regardless of the GA interval. INTERPRETATION LUS is a reliable criterion to administer the first surfactant dose regardless of GA. Its association with oxygen saturation to Fio2 ratio significantly improves the prediction power for surfactant need.
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Affiliation(s)
- Francesco Raimondi
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy.
| | - Fiorella Migliaro
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Fabio Meneghin
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Luca Pierri
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Serena Salomè
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Alessandro Perri
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Nobile
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Lama
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Varano
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Sara Gatto
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
| | - Valentina Leonardi
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Letizia Capasso
- Division of Neonatology and Department of Translational Medical Sciences, Università"Federico II" di Napoli, Naples, Italy
| | - Virgilio Paolo Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Vento
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pasquale Dolce
- Department of Public Health, Università"Federico II" di Napoli, Naples, Italy
| | - Gianluca Lista
- Neonatal Intensive Care Unit, Vittore Buzzi Children's Hospital, Milan, Italy
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18
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Glaser K, Wright CJ. Indications for and Risks of Noninvasive Respiratory Support. Neonatology 2021; 118:235-243. [PMID: 33902052 PMCID: PMC8178193 DOI: 10.1159/000515818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 01/20/2023]
Abstract
Within the last decades, therapeutic advances have significantly improved the survival of extremely preterm infants. In contrast, the incidence of major neonatal morbidities, including bronchopulmonary dysplasia, has not declined. Given the well-established relationship between exposure to invasive mechanical ventilation and neonatal lung injury, neonatologists have sought for effective strategies of noninvasive respiratory support in high-risk infants. Continuous positive airway pressure has replaced invasive mechanical ventilation for the initial stabilization and the treatment of respiratory distress syndrome. Today, noninvasive respiratory support has been adopted even in the tiniest babies with the highest risk of lung injury. Moreover, different modes of noninvasive respiratory support supplemented by a number of adjunctive measures and rescue strategies have entered clinical practice with the goal of preventing intubation or reintubation. However, does this unquestionably important paradigm shift to strategies focused on noninvasive support lull us into a false sense of security? Can we do better in (i) identifying those very immature preterm infants best equipped for noninvasive stabilization, can we improve (ii) determinants of failure of noninvasive respiratory support in the individual infant and underlying etiology, and can we enhance (iii) success of noninvasive respiratory support and (iv) better prevent ultimate harm to the developing lung? With increased survival of infants at the highest risk of developing lung injury and an unchanging burden of bronchopulmonary dysplasia, we should question indiscriminate use of noninvasive respiratory support and address the above issues.
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Affiliation(s)
- Kirsten Glaser
- Division of Neonatology, Department of Women's and Children's Health, University of Leipzig Medical Center, Leipzig, Germany
| | - Clyde J Wright
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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19
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The Predictive Value of Lung Ultrasound Scores in Developing Bronchopulmonary Dysplasia: A Prospective Multicenter Diagnostic Accuracy Study. Chest 2021; 160:1006-1016. [PMID: 33689782 DOI: 10.1016/j.chest.2021.02.066] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Different lung ultrasound (LUS) scanning protocols have been used, and the results in terms of diagnostic accuracy are heterogeneous. RESEARCH QUESTIONS What is the diagnostic accuracy of the LUS score to predict moderate to severe bronchopulmonary dysplasia (msBPD)? Does scanning of posterior lung fields improve the diagnostic accuracy? STUDY DESIGN AND METHODS This was a multicenter prospective, observational study in six centers. Two LUS aeration scores, one involving only anterolateral lung fields and the other adding the posterior fields were obtained at birth, on the third day of life (DOL), on the seventh DOL, on the 14th DOL, and on the 21st DOL. The diagnostic accuracy of both scores to predict msBPD was assessed at each time point. RESULTS Eight hundred thirty-two LUS examinations in 298 infants were included. Both LUS score using anterolateral and posterior fields and LUS score using only anterolateral fields showed a similar moderate diagnostic accuracy to predict msBPD on the third DOL (area under the receiver operating characteristic curve [AUC] 95% CI, 0.68-0.85 vs 0.68-0.85; P = .97), seventh DOL (AUC 95% CI, 0.74-0.85 vs 0.74-0.84; P = .26), and 21st DOL (AUC 95% CI, 0.72-0.86 vs 0.74-0.88; P = .17). The LUS score using anterolateral and posterior fields was slightly more accurate at 14th DOL (AUC 95% CI, 0.69-0.83 vs 0.66-0.80; P = .01). A cutoff of 8 points in the LUS score using only anterolateral fields on the seventh DOL provided a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 70%, 79%, 3.3, and 0.38, respectively, to predict msBPD. Adding gestational age (GA) and sex improved the discriminative value without significant differences compared with a predictive model based on multiple clinical variables: AUC 95% CI, 0.77-0.88 vs 0.80-0.91 (P = .52). INTERPRETATION The LUS score is able to predict msBPD from the third DOL with a moderate diagnostic accuracy. Scanning posterior lung fields slightly improved diagnostic accuracy only at the 14th DOL. Adding GA and sex improves the diagnostic accuracy of the LUS scores. The LUS score is useful to stratify BPD risk early after birth.
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20
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Aldecoa-Bilbao V, Velilla M, Teresa-Palacio M, Esponera CB, Barbero AH, Sin-Soler M, Sanz MI, Salvia Roigés MD. Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants. Neonatology 2021; 118:537-545. [PMID: 34515177 DOI: 10.1159/000517585] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. METHODS Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. RESULTS Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79-0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70-0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84-0.97), p < 0.001. CONCLUSION LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.
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Affiliation(s)
- Victoria Aldecoa-Bilbao
- Neonatology Department, Hospital Clínic Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Mar Velilla
- Neonatology Department, Hospital Sant Joan de Déu, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Teresa-Palacio
- Neonatology Department, Hospital Clínic Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Carla Balcells Esponera
- Neonatology Department, Hospital Sant Joan de Déu, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Ana Herranz Barbero
- Neonatology Department, Hospital Clínic Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Sin-Soler
- Faculty of Medicine, University of Barcelona (UB), Barcelona, Spain
| | - Martín Iriondo Sanz
- Neonatology Department, Hospital Sant Joan de Déu, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Faculty of Medicine, University of Barcelona (UB), Barcelona, Spain
| | - Maria Dolors Salvia Roigés
- Neonatology Department, Hospital Clínic Barcelona, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
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