Pathak Keshav Kumar, Maria Arti, Guleria Munish, Mall Pranaya Kumar, Sharma Abhinav
Department of Neonatology, All India Institute of Medical Sciences, Patna, Patna, IND.
Department of Neonatology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND.
Cureus. 2024 Aug 5;16(8):e66199. doi: 10.7759/cureus.66199. eCollection 2024 Aug.
Lung ultrasound (LUS) is an evolving point-of-care tool in the neonatal intensive care unit. LUS score has been evaluated in adults as well as in neonates to characterize and diagnose various respiratory conditions. Recently, the LUS score has been evaluated for predicting clinical respiratory outcomes in neonates.
To assess the association between LUS score and various modes of respiratory support and clinical outcomes among neonates presenting with respiratory distress.
In this prospective, cross-sectional, observational study done in a tertiary care neonatal unit, the LUS score was calculated within three hours of receiving respiratory support. Subsequently, the LUS score was assigned with each escalation and de-escalation of respiratory support. Maximum LUS scores for each clinical outcome were also recorded. Inter-rater agreement was determined with the intraclass correlation coefficient.
A total of 162 LUS scans were performed in 65 babies with a mean gestation of 32.4 ± 3.7 weeks and median (IQR) birth weight of 1480 (1130-2000) grams. The LUS scores (median (IQR)) of babies on continuous positive airway pressure (CPAP), noninvasive positive pressure ventilation (NIPPV), and mechanical ventilation (MV) were 4 (3-6.5), 9 (8-11), and 12 (11-13.5), respectively (p-value < 0.001). The difference in maximum median LUS scores between different clinical outcomes was statistically significant, with a p-value < 0.001. LUS score had an excellent inter-rater agreement (intraclass correlation coefficient = 0.998; p-value < 0.001).
There is an association between LUS score and different modes of respiratory support with scores increasing as the level of support increased. LUS score was also found to be related with clinical outcomes like death, extubation failure, and recovery, which could help in predicting the prognosis.
肺部超声（LUS）是新生儿重症监护病房中一种不断发展的床旁检查工具。LUS评分已在成人和新生儿中进行评估，以表征和诊断各种呼吸状况。最近，LUS评分已用于预测新生儿的临床呼吸结局。
评估LUS评分与出现呼吸窘迫的新生儿的各种呼吸支持模式及临床结局之间的关联。
在一家三级医疗新生儿病房进行的这项前瞻性、横断面观察性研究中，在接受呼吸支持的三小时内计算LUS评分。随后，在每次呼吸支持升级和降级时记录LUS评分。还记录了每种临床结局的最高LUS评分。通过组内相关系数确定评分者间的一致性。
对65例婴儿共进行了162次LUS扫描，这些婴儿的平均胎龄为32.4±3.7周，中位（IQR）出生体重为1480（1130 - 2000）克。接受持续气道正压通气（CPAP）、无创正压通气（NIPPV）和机械通气（MV）的婴儿的LUS评分（中位（IQR））分别为4（3 - 6.5）、9（8 - 11）和12（11 - 13.5）（p值<0.001）。不同临床结局之间的最高中位LUS评分差异具有统计学意义，p值<0.001。LUS评分具有极好的评分者间一致性（组内相关系数 = 0.998；p值<0.001）。
LUS评分与不同的呼吸支持模式之间存在关联，随着支持水平的提高评分增加。还发现LUS评分与死亡、拔管失败和恢复等临床结局相关，这有助于预测预后。
