Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Eur J Pediatr. 2024 Aug;183(8):3599-3606. doi: 10.1007/s00431-024-05626-z. Epub 2024 Jun 3.
Surfactant replacement for respiratory distress syndrome (RDS) is currently guided by oxygen (FiO) requirement in preterm neonates. Lung ultrasound (LUS) has emerged as an important predictive tool; however, there is a paucity of evidence from developing countries. The objective of this study was to determine the diagnostic accuracy of the LUS score in comparison to standard criteria based on FiO2 requirement for prediction of surfactant requirement. In this prospective study, preterm neonates of < 34 weeks' gestation with RDS were included within 2 h of life. Surfactant was administered if the FiO requirement exceeded 30%. Baseline characteristics, respiratory parameters, and LUS clips were recorded soon after birth and compared between the surfactant and non-surfactant groups. LUS scoring was later performed by masked assessors which was not used in the management of neonates. Among 82 neonates (mean gestation 30.6 weeks and weight 1375 g) included in the study, 33 (40.2%) received surfactant. The surfactant group had a higher Silverman score, required higher FiO and mean airway pressure, and needed invasive ventilation more frequently. The mean (± SD) LUS score was significantly higher in the surfactant (9.4 ± 3.2) compared to the non-surfactant group (5.1 ± 2.1). The diagnostic accuracy of LUS scoring was determined by ROC curve analysis (AUC (95% CI): 0.83 (0.74-0.92), p < 0.01). A cutoff score of ≥ 8 for LUS was considered optimal for the prediction of surfactant requirement (sensitivity and specificity (95% CI) of 70% (51-84) and 80% (66-90), respectively). Conclusion: Lung ultrasound is a valid diagnostic tool for the prediction of surfactant requirements in resource-limited settings. What is Known: • Lung ultrasound has a good diagnostic accuracy in predicting the need for surfactant administration in preterm neonates in developed countries, but its role in developing countries is unclear. What is New: • Lung ultrasound proved to be a valid diagnostic tool in predicting surfactant replacement therapy in resource-limited settings. • The diagnostic performance of lung ultrasound was better in neonates on non-invasive ventilation, compared to invasive ventilation.
表面活性物质替代治疗呼吸窘迫综合征（RDS）目前根据早产儿的氧（FiO ）需求来指导。肺部超声（LUS）已成为一种重要的预测工具；然而，来自发展中国家的证据很少。本研究的目的是确定 LUS 评分与基于 FiO2 需求的标准标准相比预测表面活性物质需求的诊断准确性。在这项前瞻性研究中，将胎龄 <34 周且有 RDS 的早产儿纳入出生后 2 小时内。如果 FiO 需求超过 30%，则给予表面活性物质。在出生后不久记录基线特征、呼吸参数和 LUS 剪辑，并在表面活性物质组和非表面活性物质组之间进行比较。LUS 评分由盲法评估者进行，该评分不用于新生儿的管理。在纳入的 82 名新生儿（平均胎龄 30.6 周，体重 1375g）中，33 名（40.2%）接受了表面活性物质治疗。表面活性物质组的 Silverman 评分更高，需要更高的 FiO 和平均气道压力，并且更频繁地需要有创通气。表面活性物质组的平均（±SD）LUS 评分明显高于非表面活性物质组（9.4±3.2）比（5.1±2.1）。通过 ROC 曲线分析确定 LUS 评分的诊断准确性（AUC（95%CI）：0.83（0.74-0.92），p<0.01）。LUS 评分≥8 被认为是预测表面活性物质需求的最佳截断值（预测表面活性物质需求的敏感性和特异性（95%CI）分别为 70%（51-84）和 80%（66-90））。结论：肺部超声是预测资源有限环境中表面活性物质需求的有效诊断工具。已知：• 在发达国家，肺部超声对预测早产儿表面活性物质治疗需求具有良好的诊断准确性，但在发展中国家的作用尚不清楚。新内容：• 肺部超声证明是预测资源有限环境中表面活性物质替代治疗的有效诊断工具。• 与有创通气相比，肺部超声在接受无创通气的新生儿中的诊断性能更好。
