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Lung ultrasound (LUS) and surfactant treatment: looking for the best predictive moment

Abstract

Objective

Assess the earliest time of LUS to guide surfactant therapy.

Study design

In this observational study (ClinicalTrials.gov Identifier NCT04544514), LUS was performed within 30 min and repeated at 1, 2, 4, and 6 h on preterm babies. White lung appearance was defined as type 1 group, whereas prevalence of lines B as type 2 and lines A as type 3. Ultrasound and radiographic findings were also compared to determine surfactant need.

Results

Among 71 patients, 41 received surfactant therapy. In the first evaluation, 37 of them have been defined as type 1, whereas 4 of them have been as type 2 group. Type 3 group did not receive surfactant. Type 1 findings were superior to predict surfactant need and the predictive value was 100% at 2 h.

Conclusion

Even early LUS assessment at the first 20–30 min  was more significant to predict surfactant need than x-ray. Presence of white lung appearance for 2 h indicates an absolute surfactant need.

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Fig. 1: LUS findings are divided into three groups.
Fig. 2: Patients LUS scores and flow diagram.
Fig. 3: The images of the patient who received surfactant at the sixth hour.
Fig. 4: The x-ray image of the patient who received surfactant at the sixth hour.

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References

  1. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, te Pas A, et al. European consensus guidelines on the management of respiratory distress syndrome—2019 update. Neonatology. 2019;115:432–51.

    Article  Google Scholar 

  2. Rojas-Reyes MX, Morley CJ, Soll R. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2012;3:CD000510.

    Google Scholar 

  3. Bahadue FL, Soll R. Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2012;11:CD001456.

    PubMed  Google Scholar 

  4. Polin AP, Carlo WA. Committee on fetus and newborn. surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics. 2014;133:156–63.

    Article  Google Scholar 

  5. Woods PL. Utility of lung ultrasound scanning in neonatology. Arch Dis Child. 2019;104:909–15.

    Article  Google Scholar 

  6. Copetti R, Cattarossi L, Macagno G, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatalogy. 2008;94:52–59.

    Article  Google Scholar 

  7. Raimondi F, Cattarossi L, Copetti R. Point-of-care ultrasound in the neonatal intensive care unit: an Italian perspective. NeoReviews. 2014;15:e1–5.

    Article  Google Scholar 

  8. Cattarossi L. Lung ultrasound: its role in neonatology and pediatrics. Early Hum Dev. 2013;89S1:S17–19.

    Article  Google Scholar 

  9. Raimondi F, Migliaro F, Sodano A, Ferrara T, Lama S, Vallone G, et al. Use of neonatal chest ultrasound to predict noninvasive ventilation failure. Pediatrics. 2014;134:e1089–94.

    Article  Google Scholar 

  10. Raimondi F, Migliaro F, Sodano A, Umbaldo A, Romano A, Vallone G, et al. Can neonatal lung ultrasound monitor fluid clearance and predict the need of respiratory support? Crit Care. 2012;16:R220.

    Article  Google Scholar 

  11. Escourrou G, De Luca D. Lung ultrasound decreased radiation exposure in preterm infants in a neonatal intensive care unit. Acta Paediatr. 2016;105:e237–9.

    Article  Google Scholar 

  12. Liu J, Cao HY, Wang HW, Kong XY. The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr. 2014;24:147–54.

    Google Scholar 

  13. El-Malah HEDGM, Hany S, Mahmoud MK, Ali AM. Ultrasonography in evaluation of neonatal respiratory distress syndrome. Egypt J Radiol Nucl MEd. 2015;46:469–74.

    Article  Google Scholar 

  14. Bober K, Swietlinski J. Diagnostic utility of ultrasonography for respiratory distress syndrome in neonates. Med Sci Monit. 2006;12:Cr440–6.

    PubMed  Google Scholar 

  15. Kurepa D, Zaghloul N, Watkins L, Liu J. Neonatal lung ultrasound exam guidelines. J Perinatol. 2018;38:11–22.

    Article  CAS  Google Scholar 

  16. Vergine M, Copetti R, Brusa G, Cattarossi L. Lung ultrasound accuracy in respiratory distress syndrome and transient tachypnea of the newborn. Neonatology. 2014;106:87–93.

    Article  Google Scholar 

  17. De Martino L, Yousef N, Ben-Ammar R, Raimondi F, Shankar-Aguilera S, De Luca D. Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics. 2018;142:e20180463.

    Article  Google Scholar 

  18. Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr. 2015;169:e151797.

    Article  Google Scholar 

  19. Gregorio-Hernandez R, Arriaga-Redondo M, Perez-Perez A, Ramos-Navarro C, Sanchez-Luna M. Lung ultrasound in preterm infants with respiratory distress: experience in a neonatal intensive care unit. Eur J Pediatr. 2020;179:81–89.

    Article  Google Scholar 

  20. Raschetti R, Yousef N, Vigo G, Marseglia G, Centorrino R, Ben-Ammar R, et al. Echography-guided surfactant therapy to improve timeliness of surfactant replacement: a quality improvement project. J Pediatr. 2019;212:137–43.

    Article  Google Scholar 

  21. Pang H, Zhang B, Shi J, Zang J, Qiu L. Diagnostic value of lung ultrasound in evaluating the severity of neonatal respiratory distress syndrome. Eur J Radiol. 2019;116:186–91.

    Article  Google Scholar 

  22. Perri A, Riccardi R, Iannotta R, di Molfetta DV, Arena R, Vento G, et al. Lung ultrasonography score versus chest X-ray score to predict surfactant administration in newborns with respiratory distress syndrome. Pediatr Pulmonol. 2018;53:1231–6.

    Article  Google Scholar 

  23. Blank DA, Rogerson SR, Kamlin COF, Fox LM, Lorenz L, Kane SC, et al. Lung ultrasound during the initiation of breathing in healthy term and late preterm infants immediately after birth, a prospective, observational study. Resuscitation. 2017;114:59–65.

    Article  Google Scholar 

  24. Blank DA, Kamlin COF, Rogerson SR, Fox LM, Lorenz L, Kane SC, et al. Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study. Arch Dis Child Fetal Neonatal Ed. 2018;103:F157–62.

    Article  Google Scholar 

  25. Arthur R. The neonatal chest X-ray. Pediatr Respir Rev. 2001;2:311–23.

    CAS  Google Scholar 

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Correspondence to Gozdem Kayki.

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Kayki, G., Yigit, S., Tandircioglu, U.A. et al. Lung ultrasound (LUS) and surfactant treatment: looking for the best predictive moment. J Perinatol 41, 1669–1674 (2021). https://doi.org/10.1038/s41372-021-01039-0

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