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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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Nour BA, El-Rahman AMA, Hameed SAEAE, Mohsen N, Mohamed A, El-Bayoumi MA, Abdel-Hady HE. Lung and diaphragm ultrasound as predictors of successful weaning from nasal continuous positive airway pressure in preterm infants. Pediatr Pulmonol 2024; 59:1428-1437. [PMID: 38501314 DOI: 10.1002/ppul.26933] [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: 10/23/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Assessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants. STUDY DESIGN This prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP. RESULTS Out of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning. CONCLUSION LUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.
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Affiliation(s)
- Basma Ahmed Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Nada Mohsen
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Hesham Elsayed Abdel-Hady
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Alonso-Ojembarrena A, Ehrhardt H, Cetinkaya M, Lavizzari A, Szczapa T, Sartorius V, Rocha G, Sindelar R, Wald M, Heiring C, Soukka H, Danhaive O, Roehr CC, Cucerea M, Calkovska A, Dimitriou G, Barzilay B, Klingenberg C, Schulzke S, Plavka R, Tameliene R, O'Donnell CPF, van Kaam AH. Use of neonatal lung ultrasound in European neonatal units: a survey by the European Society of Paediatric Research. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327068. [PMID: 38604653 DOI: 10.1136/archdischild-2024-327068] [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: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Regarding the use of lung ultrasound (LU) in neonatal intensive care units (NICUs) across Europe, to assess how widely it is used, for what indications and how its implementation might be improved. DESIGN AND INTERVENTION International online survey. RESULTS Replies were received from 560 NICUs in 24 countries between January and May 2023. LU uptake varied considerably (20%-98% of NICUs) between countries. In 428 units (76%), LU was used for clinical indications, while 34 units (6%) only used it for research purposes. One-third of units had <2 years of experience, and only 71 units (13%) had >5 years of experience. LU was mainly performed by neonatologists. LU was most frequently used to diagnose respiratory diseases (68%), to evaluate an infant experiencing acute clinical deterioration (53%) and to guide surfactant treatment (39%). The main pathologies diagnosed by LU were pleural effusion, pneumothorax, transient tachypnoea of the newborn and respiratory distress syndrome. The main barriers for implementation were lack of experience with technical aspects and/or image interpretation. Most units indicated that specific courses and an international guideline on neonatal LU could promote uptake of this technique. CONCLUSIONS Although LU has been adopted in neonatal care in most European countries, the uptake is highly variable. The main indications are diagnosis of lung disease, evaluation of acute clinical deterioration and guidance of surfactant. Implementation may be improved by developing courses and publishing an international guideline.
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Affiliation(s)
- Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cadiz, Spain
- Research Unit, Puerta del Mar University Hospital, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cadiz, Spain
| | - Harald Ehrhardt
- Division of Neonatology and Pediatric Intensive Care Medicine. Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
| | - Merih Cetinkaya
- Health Sciences University, Başaksehir. Cam and Sakura City Hospital, Istanbul, Turkey
| | - Anna Lavizzari
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tomasz Szczapa
- II Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Victor Sartorius
- Divivion of Paediatric and Neonatal Critical Care, Hôpital Antoine-Béclère, Clamart, France
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Richard Sindelar
- Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Martin Wald
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Paracelsus Medical University, University Hospital Salzburg, Salzburg, Austria
| | - Christian Heiring
- Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanna Soukka
- Department of Pediatrics and Adolescent Medicine, University Hosptial of Turky and Turku University, Turku, Finland
| | - Olivier Danhaive
- Division of Neonatology, Saint-Luc University Hospital, UCLouvain, Brussels, Belgium
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Charles C Roehr
- National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
- Newborn Services, Southmead Hospital, North Bristol Trust, Bristol, UK
- Newborn Services, Southmead Hospital. North Bristol Trust, Bristol, UK
| | - Manuela Cucerea
- Department of Neonatology, George Emil Palade University of Medicine Pharmacy Science and Technology of Targu Mures, Targu Mures, Romania
| | - Andrea Calkovska
- Department of Physiology, Jessenius Faculty of Medicine. Comenius University, Bratislava, Slovakia
| | | | - Bernard Barzilay
- Neonatology Division, Mayanei Hayeshua Medical Center, Bnei Brak, Tel Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Claus Klingenberg
- Paediatric Research Group, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromso, Norway
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital, Basel, Switzerland
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Rasa Tameliene
- Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development, Amsterdam, The Netherlands
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Gao Y, Yin H, Wang MH, Gao YH. Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis. Front Pediatr 2023; 11:1211306. [PMID: 37744441 PMCID: PMC10511769 DOI: 10.3389/fped.2023.1211306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although lung and diaphragm ultrasound are valuable tools for predicting weaning results in adults with MV, their relevance in children is debatable. The goal of this meta-analysis was to determine the predictive value of lung and diaphragm ultrasound in newborn weaning outcomes. Methods For eligible studies, the databases MEDLINE, Web of Science, Cochrane Library, PubMed, and Embase were thoroughly searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to evaluate the study's quality. Results were gathered for sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve of summary receiver operating characteristic curves (AUSROC). To investigate the causes of heterogeneity, subgroup analyses and meta-regression were conducted. Results A total of 11 studies were suitable for inclusion in the meta-analysis, which included 828 patients. The pooled sensitivity and specificity of lung ultrasound (LUS) were 0.88 (95%CI, 0.85-0.90) and 0.81 (95%CI, 0.75-0.87), respectively. The DOR for diaphragmatic excursion (DE) is 13.17 (95%CI, 5.65-30.71). The AUSROC for diaphragm thickening fraction (DTF) is 0.86 (95%CI, 0.82-0.89). The most sensitive and specific method is LUS. The DE and DTF were the key areas where study heterogeneity was evident. Conclusions Lung ultrasonography is an extremely accurate method for predicting weaning results in MV infants. DTF outperforms DE in terms of diaphragm ultrasound predictive power.
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Affiliation(s)
- Yang Gao
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Hong Yin
- Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China
| | - Mei-Huan Wang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yue-Hua Gao
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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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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