Utility of Lung Ultrasound Score in the Management of Respiratory Distress Syndrome in Preterm Neonates

Sacchidanand Kawde, Kavita Kanase

Abstract

Background: Lung ultrasound can be an accurate and early predictor of the need for surfactant therapy in respiratory distress syndrome (RDS). Lung ultrasound can replace chest X-ray (CXR) and FiO2 criterion in the management of RDS. There is a need to assess the predictability of lung ultrasound scores (LUS) in the developing countries, as most of the studies are from developed countries only.

Aim: This study aimed at exploring the utility of LUS in the management of RDS in preterm neonates in the Indian scenario.

Materials and Methods: This prospective, observational study was conducted in 77 preterm neonates (gestational age [GA] ≤ 34 wk) with RDS at birth, in a tertiary-level NICU in BJ Wadia Hospital (Mumbai, Maharashtra, India).

Results: Gestational age, birth weight, preterm premature rupture of membranes, sex, and Silverman–Andersen Score were significantly associated with SRT. The cutoff LUS of ≥ 7 was considered optimal for SRT (sensitivity 81.4% and specificity 88.29%). The first LUS cutoff determining the requirement of > 1 dose of surfactant was ≥ 9 (sensitivity 81.3%, specificity 91.2%, AUC [95% CI]: 0.869 [0.746−0.992], P < .001). The first LUS cutoff determining the requirement of invasive ventilation was ≥ 10 (sensitivity 82%, specificity 100%, AUC [95% CI]: 0.89 [0.80–0.99], P < .001). Similarly, the second LUS cutoff determining the requirement of the second dose of surfactant was 7 with similar accuracy.

Conclusion: A quantitative LUS is an excellent predictor of the need for SRT and invasive ventilation for RDS in preterm neonates in developing countries. The study predicted an optimal LUS cutoff of 7 and 9 that indicate the need for the first dose and the second dose of surfactant, respectively. The LUS cutoff of 10 indicated the need for invasive ventilation in neonates (GA ≤ 34 wk) with RDS.