Kartikeswar Gouda Ankula P, Parikh Tushar, Pandya Dhyey, Pandit Anand
Department of Pediatrics, Division of Neonatology, MJM Hospital, Pune, Maharashtra, India.
Department of Pediatrics, Division of Neonatology, KEM Hospital, Pune, Maharashtra, India.
Lung India. 2022 Sep-Oct;39(5):417-421. doi: 10.4103/lungindia.lungindia_13_22.
To find out the diagnostic use of lung ultrasound (LUS) in respiratory distress in neonates by taking clinico-radiological (clinical plus X-ray) diagnosis as the gold standard. Secondary objectives were to find out if modified LUS score can predict the need for surfactant therapy.
A prospective observational study was done in a tertiary care neonatal intensive care unit over a period of 1 year (January-December 2018). All pre-term infants with respiratory distress were screened with LUS and CXR within 2 h of admission and modified LUS score was calculated to find out the lung water content and its correlation with the severity of respiratory distress syndrome (RDS).
In total, 92 neonates were screened during the study period, and 61 were finally diagnosed as RDS. The Kappa statistic between the clinico-radiological diagnosis and LUS diagnosis was 0.639. LUS diagnosis and CXR diagnosis had a Kappa correlation value of 0.786 (95% CI: 0.678-0.983). The most common LUS feature in RDS was pleural line thickening (100%), followed by whiteout lungs (75.4%). The modified LUS score was higher in babies who needed surfactant therapy (median (IQR): 49 (44, 53.5) vs. 29.5 (21, 46)) (P < 0.0001).
Our study shows that LUS in neonatal RDS can predict the severity of the disease, need for surfactant therapy and has good agreement with clinical and Xray diagnosis.
以临床放射学（临床加X线）诊断为金标准，探究肺部超声（LUS）在新生儿呼吸窘迫诊断中的应用。次要目的是确定改良LUS评分是否能够预测表面活性剂治疗的需求。
在一家三级医疗新生儿重症监护病房进行了为期1年（2018年1月至12月）的前瞻性观察研究。所有呼吸窘迫的早产儿在入院后2小时内接受LUS和CXR检查，并计算改良LUS评分，以确定肺含水量及其与呼吸窘迫综合征（RDS）严重程度的相关性。
在研究期间共筛查了92例新生儿，最终61例被诊断为RDS。临床放射学诊断与LUS诊断之间的Kappa统计量为0.639。LUS诊断与CXR诊断的Kappa相关值为0.786（95%CI：0.678 - 0.983）。RDS中最常见的LUS特征是胸膜线增厚（100%），其次是肺实变（75.4%）。需要表面活性剂治疗的婴儿改良LUS评分更高（中位数（IQR）：49（44，53.5）对29.5（21，46））（P < 0.0001）。
我们的研究表明，新生儿RDS中的LUS能够预测疾病的严重程度、表面活性剂治疗的需求，并且与临床和X线诊断具有良好的一致性。
