Hiles Matthew, Culpan Anne-Marie, Watts Catriona, Munyombwe Theresa, Wolstenhulme Stephen
Department of Radiology, Hull and East Yorkshire NHS Trust, Ultrasound Department, UK.
Division of Biomedical Imaging, Faculty of Medicine & Health, University of Leeds, UK.
Ultrasound. 2017 May;25(2):80-91. doi: 10.1177/1742271X16689374. Epub 2017 Jan 29.
Neonatal respiratory distress syndrome is a leading cause of morbidity in preterm new-born babies (<37 weeks gestation age). The current diagnostic reference standard includes clinical testing and chest radiography with associated exposure to ionising radiation. The aim of this review was to compare the diagnostic accuracy of lung ultrasound against the reference standard in symptomatic neonates of ≤42 weeks gestation age.
A systematic search of literature published between 1990 and 2016 identified 803 potentially relevant studies. Six studies met the review inclusion criteria and were retrieved for analysis. Quality assessment was performed before data extraction and meta-analysis.
Four prospective cohort studies and two case control studies included 480 neonates. All studies were of moderate methodological quality although heterogeneity was evident across the studies. The pooled sensitivity and specificity of lung ultrasound were 97% (95% confidence interval [CI] 94-99%) and 91% (CI: 86-95%) respectively. False positive diagnoses were made in 16 cases due to pneumonia (n = 8), transient tachypnoea (n = 3), pneumothorax (n = 1) and meconium aspiration syndrome (n = 1); the diagnoses of the remaining three false positive results were not specified. False negatives diagnoses occurred in nine cases, only two were specified as air-leak syndromes.
Lung ultrasound was highly sensitive for the detection of neonatal respiratory distress syndrome although there is potential to miss co-morbid air-leak syndromes. Further research into lung ultrasound diagnostic accuracy for neonatal air-leak syndrome and economic modelling for service integration is required before lung ultrasound can replace chest radiography as the imaging component of the reference standard.
新生儿呼吸窘迫综合征是早产新生儿（胎龄<37周）发病的主要原因。目前的诊断参考标准包括临床检查和胸部X线摄影，这会使患儿暴露于电离辐射中。本综述的目的是比较肺超声与参考标准对胎龄≤42周有症状新生儿的诊断准确性。
系统检索1990年至2016年发表的文献，共识别出803项可能相关的研究。6项研究符合综述纳入标准并被检索出来进行分析。在数据提取和荟萃分析之前进行了质量评估。
4项前瞻性队列研究和2项病例对照研究纳入了480例新生儿。所有研究的方法学质量中等，尽管各研究之间存在明显的异质性。肺超声的合并敏感性和特异性分别为97%（95%置信区间[CI]94 - 99%）和91%（CI：86 - 95%）。16例出现假阳性诊断，原因包括肺炎（n = 8）、短暂性呼吸急促（n = 3）、气胸（n = 1）和胎粪吸入综合征（n = 1）；其余3例假阳性结果的诊断未明确说明。9例出现假阴性诊断，仅2例被明确为气漏综合征。
肺超声对新生儿呼吸窘迫综合征的检测具有高度敏感性，尽管有可能漏诊合并的气漏综合征。在肺超声能够取代胸部X线摄影作为参考标准的影像学检查之前，需要进一步研究其对新生儿气漏综合征的诊断准确性以及服务整合的经济学模型。
