Newborn Research Centre, The Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia; The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia.
Newborn Research Centre, The Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia.
Resuscitation. 2021 May;162:227-235. doi: 10.1016/j.resuscitation.2021.01.025. Epub 2021 Feb 3.
Early identification of infants requiring surfactant therapy improves outcomes. We evaluated the accuracy of delivery room lung ultrasound (LUS) to predict surfactant therapy in very- and extremely preterm infants.
Infants born at <32 weeks were prospectively enrolled at 2 centres. LUS videos of both sides of the chest were obtained 5-10 min, 11-20 min, and 1-3 h after birth. Clinicians were masked to the results of the LUS assessment and surfactant therapy was provided according to local guidelines. LUS videos were graded blinded to clinical data. Presence of unilateral type 1 ('whiteout') LUS or worse was considered test positive. Receiver Operating Characteristic (ROC) analysis compared the accuracy of LUS and an FiO threshold of 0.3 to predict subsequent surfactant therapy.
Fifty-two infants with a median age of 27 weeks (IQR 26-28) were studied. Thirty infants (58%) received surfactant. Area under the ROC curve (AUC) for LUS at 5-10 min, 11-20 min and 1-3 h was 0.78 (95% CI, 0.66-0.90), 0.76 (95% CI, 0.65-0.88) and 0.86 (95% CI, 0.75-0.97) respectively, outperforming FiO at the 5-10 min timepoint (AUC 0.45, 95% CI 0.29-0.62, p = 0.001). At 11-20 min, LUS had a specificity of 95% (95% CI 77-100%) and sensitivity of 59% (95% CI, 39-77%) to predict surfactant therapy. All infants born at 23-27 weeks with LUS test positive received surfactant. Twenty-six infants (50%) had worsening of LUS grades on serial assessment.
LUS in the delivery room and accurately predicts surfactant therapy in infants <32 weeks.
早期识别需要表面活性剂治疗的婴儿可以改善预后。我们评估了产房肺超声（LUS）预测极早产儿和超早产儿表面活性剂治疗的准确性。
前瞻性纳入在两个中心出生的胎龄<32 周的婴儿。在出生后 5-10 分钟、11-20 分钟和 1-3 小时，对双侧胸部进行 LUS 录像。临床医生对 LUS 评估结果不知情，根据当地指南提供表面活性剂治疗。LUS 录像盲法评分，单侧 1 型（“全白”）或更差的 LUS 视为阳性。受试者工作特征（ROC）分析比较 LUS 和 FiO2 阈值 0.3 预测随后表面活性剂治疗的准确性。
共研究了 52 名中位胎龄为 27 周（IQR 26-28）的婴儿。30 名（58%）婴儿接受了表面活性剂治疗。5-10 分钟、11-20 分钟和 1-3 小时 LUS 的 ROC 曲线下面积（AUC）分别为 0.78（95%CI，0.66-0.90）、0.76（95%CI，0.65-0.88）和 0.86（95%CI，0.75-0.97），优于 5-10 分钟时的 FiO2（AUC 0.45，95%CI 0.29-0.62，p=0.001）。在 11-20 分钟时，LUS 预测表面活性剂治疗的特异性为 95%（95%CI 77-100%），敏感性为 59%（95%CI 39-77%）。所有 23-27 周出生且 LUS 阳性的婴儿均接受了表面活性剂治疗。26 名（50%）婴儿在连续评估中 LUS 分级恶化。
产房内 LUS 可准确预测<32 周婴儿表面活性剂治疗的需求。
