Lung ultrasonography in the management of preterm (≤34 weeks) neonates with respiratory distress syndrome.

INTRODUCTION

The diagnosis of respiratory distress syndrome (RDS) is largely clinical with the support of a chest X-ray. Lung ultrasound (LUS) is emerging as a reliable bedside technique to evaluate RDS.

AIMS AND OBJECTIVES

To determine the LUS for preterm neonates ≤34 weeks of gestation admitted within 12 h of birth with clinical suspicion of RDS and to compare the lung USG score with the chest X-ray score to predict the need for surfactant administration.

METHODS

This prospective observational study was conducted among 67 preterm neonates with clinical suspicion of RDS admitted to our NICU. Neonates underwent a clinical examination, followed promptly by a chest X-ray and LUS. The decision to administer surfactant was made on the basis of the clinical picture and chest X-ray. The NICU team was blinded to the findings of LUS, and the radiologist was blinded to the X-ray chest report.

RESULTS

More than two-thirds (67.2%) of the enrolled neonates with clinical suspicion of RDS required surfactant administration. The median LUS score was 12 among those who needed surfactant, while it was 8 for those who did not need surfactant. A receiver operator curve was constructed for the LUS and chest X-ray scores to determine the need for surfactant administration. The area under the curve (AUC) for the LUS score was higher than that of the chest X-ray score (0.962 vs. 0.811; p < 0.001) for predicting the need for surfactant administration. The sensitivity and specificity for the LUS and chest X-ray scores were 95.6% versus 93.3% and 91% versus 50%, respectively.

CONCLUSION

The LUS score is more useful than the chest X-ray score for determining the need for surfactant in preterm neonates with RDS suspicion.