Neonatology Department, ICGON, BCNatal, Hospital Clínic - Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Neonatology. 2016;110(3):198-203. doi: 10.1159/000445932. Epub 2016 May 25.
The prognosis of neonatal respiratory distress may be difficult to estimate at admission. Lung ultrasound is a useful diagnostic tool that is quick, requires little training, and is radiation free.
This study aims to analyze whether early lung ultrasound can predict respiratory failure.
From January to December 2014, lung ultrasound was performed on neonates admitted with breathing difficulties if they were older than 32 weeks and not intubated. A neonatologist, not aware of the patient's clinical condition, analyzed the stored ultrasound images. The findings were classified into the following 2 groups according to the potential risk of a bad respiratory outcome: low risk (normal or transient tachypnea of the newborn) or high risk (respiratory distress syndrome, meconium aspiration syndrome, pneumothorax, or pneumonia). A second investigator made the same classification after reading the chest X-rays. Respiratory failure was defined as a need for mechanical ventilation during the first day of life.
In total, 105 neonates were recruited (64.8% in the low-risk sonography group and 35.2% in the high-risk sonography group). Of those, 20% needed intubation, and this was more frequent in the high-risk group (relative risk = 17.5; 95% CI 4.3-70.9, p < 0.01). As predictors of respiratory failure, lung ultrasound and chest X-ray showed a high index of agreement (κ coefficient = 0.91; 95% CI 0.83-1, p < 0.01) and good accuracy (ultrasound: 95% sensitivity, 82.5% specificity, and a negative predictive value of 98.5%).
Early lung ultrasound is a useful tool to determine which neonates admitted with respiratory distress will require mechanical ventilation. It may help the clinician to carrying out appropriate transfers.
新生儿呼吸窘迫的预后在入院时可能难以估计。肺部超声是一种快速、需要较少培训且无辐射的有用诊断工具。
本研究旨在分析早期肺部超声是否可预测呼吸衰竭。
2014 年 1 月至 12 月，对胎龄大于 32 周且未插管的呼吸困难新生儿进行肺部超声检查。一位不了解患者临床情况的新生儿科医生对存储的超声图像进行分析。根据不良呼吸结局的潜在风险，将结果分为以下 2 组：低风险（新生儿暂时性呼吸急促症或一过性呼吸增快）或高风险（呼吸窘迫综合征、胎粪吸入综合征、气胸或肺炎）。第二位研究者在阅读胸部 X 光片后进行相同的分类。呼吸衰竭定义为在生命的第 1 天需要机械通气。
共纳入 105 例新生儿（低风险组 64.8%，高风险组 35.2%）。其中，20%需要插管，高风险组更常见（相对风险=17.5；95%CI 4.3-70.9，p<0.01）。作为呼吸衰竭的预测因素，肺部超声和胸部 X 线显示出高度的一致性（κ系数=0.91；95%CI 0.83-1，p<0.01）和良好的准确性（超声：95%敏感度，82.5%特异性，阴性预测值为 98.5%）。
早期肺部超声是一种有用的工具，可确定哪些因呼吸窘迫而入院的新生儿需要机械通气。它可以帮助临床医生进行适当的转院。
