床边“即时护理肺部超声”在预测过渡期出生后不久出现呼吸窘迫的晚期早产儿和足月儿入住新生儿重症监护病房需求方面的诊断效用：一项前瞻性观察研究。
Diagnostic Utility of Bedside "Point of Care Lung Ultrasound" in Predicting the Need For NICU Admission in Late Preterm and Term Newborns Having Respiratory Distress Soon After Birth in the Transition Period: A Prospective Observational Study.
作者信息
Gautam Nirmal Kumar, H A Venkatesh, Pejaver Rajath, Nagesh Karthik
机构信息
Department of Paediatrics, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India.
Department of Neonatology, Manipal Hospital, Old Airport Road, Bengaluru, India.
出版信息
Pediatr Pulmonol. 2025 Feb;60(2):e71000. doi: 10.1002/ppul.71000.
BACKGROUND
Point of care lung ultrasound (POC-LUS) is a rapid and simple method to evaluate infants with respiratory distress after birth.
OBJECTIVES
The primary objective was to determine whether the POC-LUS score is a good predictor of NICU admission in late preterm and term infants born with respiratory distress when performed within the first 2 h of life. The secondary objective was to find a correlation between the LUS score and the clinical respiratory distress severity score.
METHODS
A prospective observational study was carried out in a tertiary care neonatal unit (Level III) over 1 year on 97 late preterm and term infants having respiratory distress at birth. POC-LUS was performed in a transition nursery area within 2 h of birth, and LUS score was recorded as per a pre-validated LUS scoring system. The decision for NICU admission was independently taken by the medical team based on clinical criteria and blinded to the LUS findings. A receiver operating characteristic (ROC) curve was generated to predict NICU admission based on the LUS score. LUS score was also analyzed for correlation with clinical respiratory distress severity scoring, that is, Silverman-Anderson score (SA score).
RESULTS
The mean gestational age of the infants in the study was 37.45 ± 1.88 weeks. Fourty-three percent of infants needed NICU admission. LUS score > 5/18 performed within 2 h after birth was an excellent predictor of NICU admission in late preterm and term infants with respiratory distress after birth (area under ROC curve 0.903, sensitivity 64%, specificity 98%, positive likelihood ratio 35, and p < 0.001). LUS score also had a weak positive correlation with the SA score (Pearson's correlation, r = 0.325; p = 0.001).
CONCLUSION
A LUS score of > 5/18 is an excellent predictor of NICU admission in term and late-preterm infants with respiratory distress after birth.
背景
床旁肺部超声（POC-LUS）是评估出生后出现呼吸窘迫的婴儿的一种快速且简单的方法。
目的
主要目的是确定在出生后2小时内进行POC-LUS评分是否是晚期早产儿和足月儿出生时伴有呼吸窘迫入住新生儿重症监护病房（NICU）的良好预测指标。次要目的是找出肺部超声（LUS）评分与临床呼吸窘迫严重程度评分之间的相关性。
方法
在一家三级护理新生儿病房（三级水平）进行了一项为期1年的前瞻性观察研究，研究对象为97例出生时伴有呼吸窘迫的晚期早产儿和足月儿。在出生后2小时内在过渡保育区进行POC-LUS检查，并根据预先验证的LUS评分系统记录LUS评分。医疗团队根据临床标准独立做出入住NICU的决定，且对LUS检查结果不知情。根据LUS评分生成受试者工作特征（ROC）曲线以预测入住NICU情况。还分析了LUS评分与临床呼吸窘迫严重程度评分即Silverman-Anderson评分（SA评分）之间的相关性。
结果
研究中婴儿的平均胎龄为37.45±1.88周。43%的婴儿需要入住NICU。出生后2小时内LUS评分>5/18是晚期早产儿和足月儿出生后伴有呼吸窘迫入住NICU的良好预测指标（ROC曲线下面积为0.903，敏感性为64%，特异性为98%，阳性似然比为35，p<0.001）。LUS评分与SA评分也呈弱正相关（Pearson相关性，r = 0.325；p = 0.001）。
结论
LUS评分>5/18是足月儿和晚期早产儿出生后伴有呼吸窘迫入住NICU的良好预测指标。
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