Sett Arun, Foo Gillian, Ngeow Alvin, Thomas Niranjan, Kee Penny P L, Zayegh Amir, Hodgson Kate A, Donath Susan M, Tingay David G, Davis Peter G, Manley Brett J, Rogerson Sheryle R
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
Newborn Services, Joan Kirner Women's and Children's, Sunshine Hospital, Western Health, Melbourne, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed. 2025 Feb 21;110(2):185-190. doi: 10.1136/archdischild-2024-327172.
To determine the accuracy of pre-extubation lung ultrasound (LUS) to predict reintubation in preterm infants born <32 weeks' gestation.
Prospective diagnostic accuracy study.
Two neonatal intensive care units.
Anterior and lateral LUS was performed pre-extubation. The primary outcome was the accuracy of LUS scores (range 0-24) to predict reintubation within 72 hours. Secondary outcomes were accuracy in predicting (1) reintubation within 7 days, (2) reintubation stratified by postnatal age and (3) accuracy of lateral imaging only (range 0-12). Pre-specified subgroup analyses were performed in extremely preterm infants born <28 weeks' gestation. Cut-off scores, sensitivities and specificities were calculated using receiver operating characteristic analysis and reported as area under the curves (AUCs).
One hundred preterm infants with a mean (SD) gestational age of 27.4 (2.2) weeks and birth weight of 1059 (354) g were studied. Thirteen were subsequently reintubated. The AUC (95% CI) of the pre-extubation LUS score for predicting reintubation was 0.63 (0.45-0.80). Accuracy was greater in extremely preterm infants: AUC 0.70 (0.52-0.87) and excellent in infants who were <72 hours of age at the time of extubation: AUC 0.90 (0.77-1.00). Accuracy was poor in infants who were >7 days of age. Lateral imaging alone demonstrated similar accuracy to scanning anterior and lateral regions.
In contrast to previous studies, LUS was not a strong predictor of reintubation in preterm infants. Accuracy is increased in extremely preterm infants. Future research should focus on infants at highest risk of extubation failure and consider simpler imaging protocols.
Australian New Zealand Clinical Trials Registry: ACTRN12621001356853.
确定拔管前肺部超声（LUS）预测孕周小于32周的早产儿再次插管的准确性。
前瞻性诊断准确性研究。
两个新生儿重症监护病房。
在拔管前进行前位和侧位LUS检查。主要结局是LUS评分（范围0 - 24）预测72小时内再次插管的准确性。次要结局包括预测（1）7天内再次插管、（2）按出生后年龄分层的再次插管以及（3）仅侧位成像（范围0 - 12）的准确性。对孕周小于28周的极早产儿进行预先指定的亚组分析。使用受试者工作特征分析计算截断分数、敏感性和特异性，并报告为曲线下面积（AUC）。
研究了100例平均（标准差）孕周为27.4（2.2）周、出生体重为1059（354）g的早产儿。其中13例随后再次插管。拔管前LUS评分预测再次插管的AUC（95%CI）为0.63（0.45 - 0.80）。极早产儿的准确性更高：AUC为0.70（0.52 - 0.87），拔管时年龄小于72小时的婴儿准确性极佳：AUC为0.90（0.77 - 1.00）。年龄大于7天的婴儿准确性较差。仅侧位成像显示出与扫描前位和侧位区域相似的准确性。
与先前的研究相反，LUS并非早产儿再次插管的有力预测指标。极早产儿的准确性有所提高。未来的研究应聚焦于拔管失败风险最高的婴儿，并考虑更简单的成像方案。
澳大利亚新西兰临床试验注册中心：ACTRN12621001356853。
