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Moreno-Espinosa AL, Hawkins-Villarreal A, Coronado-Gutierrez D, Burgos-Artizzu XP, Martínez-Portilla RJ, Peña-Ramirez T, Gallo DM, Hansson SR, Gratacòs E, Palacio M. Prediction of Neonatal Respiratory Morbidity Assessed by Quantitative Ultrasound Lung Texture Analysis in Twin Pregnancies. J Clin Med 2022; 11:jcm11164895. [PMID: 36013134 PMCID: PMC9409975 DOI: 10.3390/jcm11164895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to evaluate the performance of quantitative ultrasound of fetal lung texture analysis in predicting neonatal respiratory morbidity (NRM) in twin pregnancies. This was an ambispective study involving consecutive cases. Eligible cases included twin pregnancies between 27.0 and 38.6 weeks of gestation, for which an ultrasound image of the fetal thorax was obtained within 48 h of delivery. Images were analyzed using quantusFLM® version 3.0. The primary outcome of this study was neonatal respiratory morbidity, defined as the occurrence of either transient tachypnea of the newborn or respiratory distress syndrome. The performance of quantusFLM® in predicting NRM was analyzed by matching quantitative ultrasound analysis and clinical outcomes. This study included 166 images. Neonatal respiratory morbidity occurred in 12.7% of cases, and it was predicted by quantusFLM® analysis with an overall sensitivity of 42.9%, specificity of 95.9%, positive predictive value of 60%, and negative predictive value of 92.1%. The accuracy was 89.2%, with a positive likelihood ratio of 10.4, and a negative likelihood ratio of 0.6. The results of this study demonstrate the good prediction capability of NRM in twin pregnancies using a non-invasive lung texture analysis software. The test showed an overall good performance with high specificity, negative predictive value, and accuracy.
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Affiliation(s)
- Ana L. Moreno-Espinosa
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Department of Obstetrics and Gynecology, Hospital Santo Tomás, Universidad de Panamá, Panama City 07096, Panama
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico
- Correspondence: ; Tel.: +34-932-27-54-00 (ext. 7281)
| | - Ameth Hawkins-Villarreal
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Department of Obstetrics and Gynecology, Hospital Santo Tomás, Universidad de Panamá, Panama City 07096, Panama
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico
| | - David Coronado-Gutierrez
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Transmural Biotech SL, 08021 Barcelona, Spain
| | - Xavier P. Burgos-Artizzu
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Transmural Biotech SL, 08021 Barcelona, Spain
| | - Raigam J. Martínez-Portilla
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine, Mexico City 06720, Mexico
- Clinical Research Branch, National Institute of Perinatology, Mexico City 11000, Mexico
| | - Tatiana Peña-Ramirez
- School of Medicine, Universidad del Valle, Cali 760032, Colombia
- Department of Obstetrics and Gynecology, Hospital Universitario del Valle Evaristo García E.S.E., Cali 760043, Colombia
| | - Dahiana M. Gallo
- School of Medicine, Universidad del Valle, Cali 760032, Colombia
- Department of Obstetrics and Gynecology, Hospital Universitario del Valle Evaristo García E.S.E., Cali 760043, Colombia
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden
- Skåne University Hospital, 214 28 Malmö, Sweden
| | - Eduard Gratacòs
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - Montse Palacio
- BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, 08028 Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
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Moreno-Espinosa AL, Hawkins-Villarreal A, Burgos-Artizzu XP, Coronado-Gutierrez D, Castelazo S, Lip-Sosa DL, Fuenzalida J, Gallo DM, Peña-Ramirez T, Zuazagoitia P, Muñoz M, Parra-Cordero M, Gratacòs E, Palacio M. Concordance of the risk of neonatal respiratory morbidity assessed by quantitative ultrasound lung texture analysis in fetuses of twin pregnancies. Sci Rep 2022; 12:9016. [PMID: 35637275 PMCID: PMC9151662 DOI: 10.1038/s41598-022-13047-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 05/11/2022] [Indexed: 11/09/2022] Open
Abstract
To evaluate the concordance of the risk of neonatal respiratory morbidity (NRM) assessed by quantitative ultrasound lung texture analysis (QuantusFLM) between twin fetuses of the same pregnancy. Prospective study conducted in twin pregnancies. Fetal ultrasound lung images were obtained at 26.0–38.6 weeks of gestation. Categorical (high or low) and continuous results of the risk of NRM were compared between twins. Fetal ultrasound lung images from 131 pairs (262 images) of twins were included. The images were classified into three gestational age ranges: Group 1 (26.0–29.6 weeks, 78 images, 39 pairs [29.8%]); Group 2 (30.0–33.6 weeks, 98 images, 49 pairs [37.4%]) and Group 3 (34.0–38.6 weeks, 86 images, 43 pairs [32.8%]). Concordance was good in Groups 1 and 3 and moderate in Group 2. In Groups 2 and 3 at least one fetus presented high-risk results in 26.5% and 11.6% of twin pairs, respectively. Only gestational age < 32 weeks, gestational diabetes mellitus, and spontaneous conception were associated with a high risk of NRM in Group 2. There was good concordance of the risk of NRM between twins < 30.0 weeks and > 34.0 weeks. From 30.0 to 33.6 weeks 26.5% of the twin pairs had discordant results, with moderate concordance of the risk of NRM.
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Risk assessment for neonatal RDS/TTN using gestational age and the amniotic lamellar body count in twin pregnancies. Clin Chim Acta 2015; 451:301-4. [PMID: 26477481 DOI: 10.1016/j.cca.2015.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The amniotic lamellar body count (LBC) is useful for predicting respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in twin pregnancies. However, the risk of neonatal respiratory complications varies with gestational age (GA). We herein created a model to predict the risk for RDS and TTN using GA and the LBC in twin pregnancies. METHODS Six hundred thirty-two amniotic fluid samples, comprising 169 dichorionic twin (DCT) and 147 monochorionic twin (MCT) gestations, were obtained at Cesarean section. The samples were analyzed immediately without centrifugation. A logistic regression model including the LBC and GA was used to develop the prediction model for RDS/TTN. RESULTS There were 101 neonates (16.0%) with RDS/TTN. The GA and LBC were significant independent factors affecting RDS/TTN. According to the logistic regression model, we determined the probability of RDS/TTN given the values of GA and the LBC. The overall diagnostic accuracy for predicting neonatal RDS/TTN using GA and the LBC was higher than the use of the LBC alone. CONCLUSIONS GA-specific LBC cutoffs for the risk assessment of neonatal RDS/TTN have been considered to be more accurate in twin pregnancies. Our findings provide valuable, new information for the management of twin pregnancies.
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Moore ES, Elnaggar AC, Wareham JA, Ramsey CJ, Sumners JE. Neonatal functional lung maturity relative to gestational age at delivery, fetal growth, and pregnancy characteristics in triplet births. J Matern Fetal Neonatal Med 2011; 25:78-83. [PMID: 21854124 DOI: 10.3109/14767058.2011.613973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if functional lung maturity (FtLM) of triplets was affected by differentiating factors within the triplet set. METHODS This was a retrospective cohort study of triplets. Data were collected on maternal, pregnancy and neonatal characteristics and FtLM was determined, based on selected neonatal outcomes. RESULTS Functional lung immaturity (FtLI) was found in 35.5% of the infants and occurred in those born between 28.1 and 34.6 weeks gestation. Gestational age at delivery, pre-pregnancy BMI, and gestational diabetes were predictive of an infant having FtLM; while infertility treatment, pre-pregnancy BMI, and preeclampsia were predictors of FtLM discordance. CONCLUSIONS Our results demonstrated FtLI was likely at early gestation (<28 weeks) and FtLM was probable beyond 35 weeks. Discordance for FtLM was likely at 32 weeks; therefore, clinicians should guard against complacency that this gestational mark assures an uncomplicated respiratory course for all infants within the set.
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Torday JS, Rehan VK. Testing for fetal lung maturation: a biochemical "window" to the developing fetus. Clin Lab Med 2003; 23:361-83. [PMID: 12848449 DOI: 10.1016/s0272-2712(03)00030-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fetal lung maturity testing represents a major milestone in perinatology. This article critically evaluates specific controversies regarding the methodologies used to measure pulmonary surfactant in AF and how well each of these techniques performs both in principle and application. The clinical utility of fetal lung maturity testing as it applies to particularly difficult complications of pregnancy is discussed. These technical and clinical issues are framed by the scientific and empiric evidence that is used as the rationale for such testing and its implementation in the effective management of preterm delivery.
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Affiliation(s)
- J S Torday
- Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Research and Education Institute, University of California-Los Angeles, 1124 West Carson Street, Torrance, CA 90502-2006, USA.
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