Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China.
Eur J Pediatr. 2021 Sep;180(9):2781-2789. doi: 10.1007/s00431-021-04021-2. Epub 2021 Mar 23.
This study aimed to evaluate the predictive ability of lung ultrasound (LU) in the development of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. A total of 130 VLBW infants with gestational age < 32 weeks were included; LU was performed at days 1, 2, 3, 6, 9, 12, and 15 postnatally. We calculated the LU score by 12-region, 10-region, and 6-region protocols. The incidence of BPD according to the National Institutes of Health (NIH) 2001 definition and 2019 criteria was 38.5% and 64.6%, respectively. By 12-region and 10-region protocols, LU predicted BPD from the 9 to 15 days of life (DOLs) regardless of the criteria used, with an area under the curve (AUC) ranging from 0.826 (95% confidence interval (CI): 0.750-0.887) to 0.877 (95% CI: 0.807-0.928). According to the 2019 BPD definition, the LU score incorporated gestational age, and invasive mechanical ventilation >6 days predicted BPD on the 6 DOL with an AUC of 0.862 (95% CI: 0.790-0.916). The 6-region protocol had significantly smaller AUC values on the 6 and 9 DOLs than the other two protocols.Conclusion: The 12-region and 10-region LU scoring protocols are superior to the 6-region protocol in the prediction of BPD. LU can predict the development of BPD from the 9 to 15 DOLs. With the addition of clinical variables, the earliest prediction time was the 6 DOL. What is Known: • Bronchopulmonary dysplasia is the most common and adverse complication of prematurity. Recent four studies found that lung ultrasound score or findings predicted the development of bronchopulmonary dysplasia. What is New: • We present analysis by classical 6-region and the other two lung ultrasound score (10-region and 12-region) which include an assessment of the posterior lung to allow to understand what is the best score to be used. In addition, we explore whether LU-incorporated clinical variables could improve the predictive value for BPD.
本研究旨在评估肺部超声（LU）在极低出生体重（VLBW）婴儿支气管肺发育不良（BPD）发展中的预测能力。共纳入 130 例胎龄<32 周的 VLBW 婴儿；在出生后第 1、2、3、6、9、12 和 15 天进行 LU 检查。我们根据 12 区、10 区和 6 区方案计算 LU 评分。根据美国国立卫生研究院（NIH）2001 年和 2019 年标准，BPD 的发生率分别为 38.5%和 64.6%。通过 12 区和 10 区方案，无论使用何种标准，LU 均可在第 9 至 15 天预测 BPD，曲线下面积（AUC）范围为 0.826（95%置信区间（CI）：0.750-0.887）至 0.877（95%CI：0.807-0.928）。根据 2019 年 BPD 定义，将 LU 评分与胎龄相结合，且有创机械通气>6 天可预测第 6 天的 BPD，AUC 为 0.862（95%CI：0.790-0.916）。第 6 区方案在第 6 天和第 9 天的 AUC 值明显小于其他两种方案。结论：12 区和 10 区 LU 评分方案优于 6 区方案，可预测 BPD 从第 9 天至第 15 天的发生。随着临床变量的增加，最早的预测时间为第 6 天。已知：•支气管肺发育不良是早产儿最常见和最不利的并发症。最近四项研究发现，肺部超声评分或发现可预测支气管肺发育不良的发生。新发现：•我们分析了经典的 6 区方案和另外两种肺部超声评分（10 区和 12 区），包括对后肺的评估，以了解哪种评分方案最适用。此外，我们还探讨了 LU 纳入临床变量是否可以提高预测 BPD 的价值。
