Department of Pediatrics, Division of Neonatology, Zeynep Kamil Maternity and Children's Training and Research Hospital-Istanbul, University of Health Sciences, Istanbul, Turkey.
J Ultrasound Med. 2022 Feb;41(2):417-425. doi: 10.1002/jum.15720. Epub 2021 Apr 19.
To investigate the role of lung ultrasonography (LU) in predicting noninvasive ventilation (NIV) failure and the relationship between lung ultrasonography scores (LUS) with clinical outcomes in neonatal respiratory failure (NRF).
A prospective, cross-sectional study was conducted in newborns with NRF who needed NIV and were evaluated by LU. The first LUS (LUS1) was calculated at 2-6 hours and the second (LUS2) at 12-24 hours of life. The patients were divided into NIV failure and NIV non-failure groups. The relationship between LUS and clinical outcomes was evaluated.
Among 157 neonates, the median (interquartile range) of gestational week and birth weight were 37 weeks (34-39), and 2890 grams (2045-3435), respectively. The reasons for NRF were transient tachypnea of the newborn (n = 92, 58.6%), congenital pneumonia (n = 58, 36.9%), and respiratory distress syndrome (n = 7, 4.5%). The rate of NIV failure was 17.8% (n = 28). Both LUS1 and LUS2 were significantly higher in neonates with NIV failure compared to neonates with NIV non-failure (P = .001). A cutoff value of LUS1 ≥ 4 predicted NIV failure with 96% sensitivity and 63% specificity. There were positive correlations between LUS and PEEP values, IMV and total MV days, carbon dioxide values, length of hospital stay, and antibiotic days (ρ , P = .843, <.001; .474, <.001; .444, <.001; .258, .001; .212, .008; .270, <.001, respectively).
Lung ultrasound scores were higher in neonates with NIV failure than with NIV non-failure group, and strongly correlated with end-expiratory pressure values. Lung ultrasound scores were found to be related with some of the clinical outcomes of the NRF, and this suggested that LUS could provide information about the prognosis of NRF.
探讨肺部超声（Lung ultrasonography，LU）在预测无创通气（Noninvasive ventilation，NIV）失败中的作用，以及新生儿呼吸衰竭（Neonatal respiratory failure，NRF）中 LUS 评分（Lung ultrasonography scores，LUS）与临床结局的关系。
本前瞻性、横断面研究纳入了需要 NIV 且接受 LU 评估的 NRF 新生儿。在生后 2-6 小时和 12-24 小时计算首次 LUS（LUS1）和第二次 LUS（LUS2）。将患者分为 NIV 失败和 NIV 非失败组。评估 LUS 与临床结局的关系。
157 例新生儿中，中位（四分位间距）胎龄和出生体重分别为 37 周（34-39 周）和 2890 克（2045-3435 克）。NRF 的原因包括新生儿暂时性呼吸急促（n=92，58.6%）、先天性肺炎（n=58，36.9%）和呼吸窘迫综合征（n=7，4.5%）。NIV 失败率为 17.8%（n=28）。与 NIV 非失败组相比，NIV 失败组的 LUS1 和 LUS2 均显著升高（P=0.001）。LUS1≥4 的截断值预测 NIV 失败的敏感度为 96%，特异度为 63%。LUS 与 PEEP 值、IMV 和总 MV 天数、二氧化碳值、住院时间和抗生素使用天数呈正相关（ρ，P=0.843，<.001；.474，<.001；.444，<.001；.258，<.001；.212，<.008；.270，<.001）。
与 NIV 非失败组相比，NIV 失败组的 LUS 评分更高，且与呼气末正压（PEEP）值密切相关。LUS 评分与 NRF 的部分临床结局相关，提示 LUS 可提供 NRF 预后信息。
