Grasso Fiorentino, Migliaro Fiorella, Veropalumbo Claudio, Salomè Serena, Corsini Iuri, Dani Carlo, De Luca Daniele, Raimondi Francesco, Capasso Letizia
Division of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy.
Division of Neonatology, Careggi University Hospital, Florence, Italy.
Eur J Pediatr. 2025 Jul 1;184(7):460. doi: 10.1007/s00431-025-06300-8.
Chest radiograph (CR) has traditionally been the standard in imaging neonatal respiratory diseases. Lung ultrasound (LUS) has recently emerged as a radiation-free alternative. This scoping review compares the reliability of these two techniques for diagnosing respiratory distress syndrome (RDS), evaluating the need of surfactant replacement, and predicting the development of bronchopulmonary dysplasia (BPD). A literature search was conducted in PubMed, Embase, and Cochrane Library for studies published between 1974 and December 2024. The following search terms were used: "neonate," "lung ultrasound," "chest radiography," "reliability," "Respiratory Distress Syndrome," "Bronchopulmonary Dysplasia," and "surfactant administration." The search was limited to full articles. Only studies evaluating the inter- and intra-observer agreement were included. Out of 322 evaluated papers, 14 met the inclusion criteria and were included in this review. LUS had four papers (308 neonates) for RDS diagnosis with Cohen's k or intraclass correlation coefficient (ICC) ≥ 0.9, four studies (480 neonates) for the need of surfactant replacement with Cohen's k ≥ 0.83, and three papers for BPD prediction (280 infants) showing a Cohen's k ≥ 0.82. We found no publication on CR reliability for RDS diagnosis, one paper on 56 neonates on its prediction of surfactant need with a Cohen's k = 0.86, and two studies (146 neonates) on BPD prediction with Cohen's k ranging from 0.19 to 0.41.
We show that, unlike CR, LUS has good quality evidence in favor of its reliability for both diagnosis and prognosis of significant neonatal respiratory diseases and guiding surfactant delivery.
• CR has traditionally been the standard imaging method for neonatal respiratory diseases. • LUS has emerged as a radiation-free and highly accurate alternative.
• This review indicates that LUS offers robust evidence of its high reliability for the diagnosis and prognosis of neonatal respiratory distress syndrome, and for guiding surfactant delivery. In stark contrast, there is a concerning absence of solid evidence regarding CR's reliability for the aforementioned conditions.
传统上，胸部X光片（CR）一直是新生儿呼吸系统疾病成像的标准方法。肺部超声（LUS）最近作为一种无辐射的替代方法出现。本综述比较了这两种技术在诊断呼吸窘迫综合征（RDS）、评估表面活性剂替代需求以及预测支气管肺发育不良（BPD）发展方面的可靠性。在PubMed、Embase和Cochrane图书馆中进行了文献检索，以查找1974年至2024年12月期间发表的研究。使用了以下检索词：“新生儿”、“肺部超声”、“胸部X光摄影”、“可靠性”、“呼吸窘迫综合征”、“支气管肺发育不良”和“表面活性剂给药”。检索仅限于全文文章。仅纳入评估观察者间和观察者内一致性的研究。在322篇评估论文中，14篇符合纳入标准并被纳入本综述。LUS有4篇论文（308例新生儿）用于RDS诊断，Cohen's k或组内相关系数（ICC）≥0.9；4项研究（480例新生儿）用于评估表面活性剂替代需求，Cohen's k≥0.83；3篇论文用于BPD预测（280例婴儿），Cohen's k≥0.82。我们未找到关于CR在RDS诊断可靠性方面的出版物，有1篇关于56例新生儿预测表面活性剂需求的论文，Cohen's k = 0.86，以及2项关于BPD预测的研究（146例新生儿），Cohen's k范围为0.19至0.41。
我们表明，与CR不同，LUS有高质量证据支持其在诊断和预后重要新生儿呼吸系统疾病以及指导表面活性剂给药方面的可靠性。
• 传统上，CR一直是新生儿呼吸系统疾病的标准成像方法。• LUS已成为一种无辐射且高度准确的替代方法。
• 本综述表明，LUS为其在新生儿呼吸窘迫综合征的诊断和预后以及指导表面活性剂给药方面的高可靠性提供了有力证据。与之形成鲜明对比的是，关于CR在上述情况的可靠性，令人担忧地缺乏确凿证据。
