De Luca Daniele, Alonso-Ojembarrena Almudena, Sarcina Davide, Gutierrez-Rosa Irene, Loi Barbara, Migliaro Fiorella, Capasso Letizia, Raimondi Francesco
Division of Paediatrics and Neonatal Critical Care, "A. Béclère" Hospital, APHP-Paris Saclay University, Paris, France; Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France.
Neonatal Intensive Care Unit, Puerta del Mar University Hospital, Cádiz, Spain; Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
EBioMedicine. 2025 Jul 25;118:105865. doi: 10.1016/j.ebiom.2025.105865.
The most critically ill neonates may require repeated surfactant doses, but there are no consensus criteria for retreatment. We aim to verify whether lung ultrasound (LUS) aeration score predicts surfactant retreatment with accuracy equal to that known for the first administration.
This was a multicentre, retrospective, non-inferiority, diagnostic accuracy study. Preterm (≤30 weeks' gestation) neonates were enrolled and LUS aeration score was calculated at T1 (i.e., ≈1 h of life) and before surfactant administration, if any; and T2: ≈12 h of life and at least 10 h after the first surfactant administration. The area under the curve (AUC) was chosen considering the score as triage (i.e., highest sensitivity) and replacement test (i.e., highest global accuracy).
AUC was higher for T2 (AUC = 0.854 (95% CI: 0.84; 0.87), p < 0.0001) than for T1 score (AUC = 0.69 (95% CI: 0.67; 0.71), p < 0.0001; difference = 0.165 (95% CI: 0.116; 0.214), p < 0.001). AUC of T2 score was similar to that previously reported at T1 for prediction of the first surfactant treatment in preterm (p = 0.225) or in late preterm/term patients (p = 0.579). Cut-offs to use the T2 score as triage (score = 4) or replacement (score = 8) test had a sensitivity of 98% and a global accuracy of 78%, respectively. Accuracy is independent of gestational age, and the T2 score is associated with the surfactant retreatment (aOR = 1.57 (95% CI: 1.38; 1.79), p < 0.001).
In preterm neonates, LUS aeration score calculated at ≈12 h of life and at least 10 h after the first surfactant administration predicts retreatment with accuracy equal to that of the score calculated at ≈1 h of life to predict the first administration. The accuracy is independent of gestational age.
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病情最危重的新生儿可能需要重复使用表面活性剂，但对于再次治疗尚无共识性标准。我们旨在验证肺部超声（LUS）通气评分预测表面活性剂再次治疗的准确性是否与首次给药时已知的准确性相当。
这是一项多中心、回顾性、非劣效性诊断准确性研究。纳入孕周≤30周的早产儿，在T1（即出生后约1小时）以及（如有）表面活性剂给药前计算LUS通气评分；在T2（出生后约12小时且在首次表面活性剂给药后至少10小时）计算LUS通气评分。将该评分视为分诊（即最高敏感性）和替代试验（即最高总体准确性）来选择曲线下面积（AUC）。
T2时的AUC（AUC = 0.854（95%CI：0.84；0.87），p < 0.0001）高于T1评分时的AUC（AUC = 0.69（95%CI：0.67；0.71），p < 0.0001；差异 = 0.165（95%CI：0.116；0.214），p < 0.001）。T2评分的AUC与先前报道的T1时预测早产儿（p = 0.225）或晚期早产儿/足月儿（p = 0.579）首次表面活性剂治疗的AUC相似。将T2评分用作分诊（评分 = 4）或替代（评分 = 8）试验的截断值，敏感性分别为98%，总体准确性分别为78%。准确性与孕周无关，T2评分与表面活性剂再次治疗相关（校正优势比 = 1.57（95%CI：1.38；1.79），p < 0.001）。
在早产儿中，出生后约12小时且在首次表面活性剂给药后至少10小时计算的LUS通气评分预测再次治疗的准确性与出生后约1小时计算的评分预测首次给药的准确性相当。准确性与孕周无关。
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