Elgendy Essam Mahmoud, Elmahdy Heba Saied, Nassar Mohamed Abd Elatif, Zidan Lamiaa Khaled, Eltomey Mohamed Adel, Elsharkawy Hamed Mohamed
Pediatric Department, Faculty of Medicine, Tanta University, Gharbia Governorate, El Bahr St., Tanta Qism2, Tanta, 31527, Egypt.
Radiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Eur J Pediatr. 2025 Dec 9;185(1):3. doi: 10.1007/s00431-025-06605-8.
Non-invasive ventilation (NIV) remains the standard of care for preterm infants with respiratory distress syndrome (RDS); however, NIV failure is frequent and often linked to adverse outcomes. This study evaluated diaphragmatic ultrasound and thoracic fluid content (TFC) as early predictors of NIV failure in preterm neonates. In this prospective randomized controlled trial, 90 preterm neonates (28-34 gestational weeks) with RDS requiring NIV as initial respiratory support were randomized into three groups: (1) nasal continuous positive airway pressure (nCPAP), (2) nasal intermittent positive pressure ventilation (NIPPV), and (3) nasal high-frequency oscillatory ventilation (NHFOV). Diaphragmatic thickening fraction (DTF) and excursion (DE) were measured by ultrasound, while TFC was assessed using electrical cardiometry (EC). Measurements were obtained within the first 3 h of life and repeated either at 24 h in successful cases or immediately before intubation in failed cases. DTF and DE were significantly higher in neonates with successful NIV compared with those who failed (all p < 0.001), while TFC was significantly higher in failed cases within NIPPV and NHFOV groups (p < 0.001). DTF and DE showed excellent predictive accuracy (AUC 0.90 and 0.89), outperforming TFC (AUC 0.81, p < 0.01). Both DTF (adjusted OR = 0.89, 95% CI 0.83-0.96) and DE (adjusted OR = 0.38, 95% CI 0.20-0.73) independently predicted NIV failure. The combined DTF-TFC model provided the highest discrimination (AUC 0.93, 95% CI 0.89-0.97).
Diaphragmatic ultrasound and TFC-derived EC represent simple, non-invasive, and reliable tools for predicting NIV failure in preterms with RDS.
clinicaltrials.gov/ NCT07148102; registered August 22, 2025.
• NIV is widely used in preterm neonates with RDS, but predicting NIV failure remains challenging. Lung ultrasound score and thoracic fluid content have been explored as bedside predictors of NIV outcomes, with variable accuracy.. • Diaphragmatic ultrasound parameters (DTF and DE) have shown potential in assessing respiratory function in neonates.
• DTF and DE measured by ultrasound show a strong correlation with TFC obtained by EC in predicting NIV failure. Additionally, DTF and DE have higher predictive accuracy than TFC in identifying preterm neonates at risk of NIV failure. • Early assessment of DTF and DE may serve as a valuable bedside tool for monitoring lung function during early application of NIV in preterm infants.
无创通气（NIV）仍然是患有呼吸窘迫综合征（RDS）的早产儿的标准治疗方法；然而，NIV失败很常见，并且常常与不良结局相关。本研究评估了膈肌超声和胸腔液体含量（TFC）作为早产儿NIV失败的早期预测指标。在这项前瞻性随机对照试验中，90例患有RDS且需要NIV作为初始呼吸支持的早产儿（孕28 - 34周）被随机分为三组：（1）鼻持续气道正压通气（nCPAP），（2）鼻间歇正压通气（NIPPV），以及（3）鼻高频振荡通气（NHFOV）。通过超声测量膈肌增厚分数（DTF）和偏移（DE），而使用心电描记法（EC）评估TFC。在出生后的前3小时内进行测量，成功病例在24小时时重复测量，失败病例在插管前立即重复测量。与NIV失败的新生儿相比，成功进行NIV的新生儿的DTF和DE显著更高（所有p < 0.001），而在NIPPV和NHFOV组中失败病例的TFC显著更高（p < 0.001）。DTF和DE显示出优异的预测准确性（AUC分别为0.90和0.89），优于TFC（AUC为0.81，p < 0.01）。DTF（调整后的OR = 0.89，95% CI 0.83 - 0.96）和DE（调整后的OR = 0.38，95% CI 0.20 - 0.73）均独立预测NIV失败。联合DTF - TFC模型具有最高的辨别力（AUC 0.93，95% CI 0.89 - 0.97）。
膈肌超声和源自TFC的EC是预测患有RDS的早产儿NIV失败的简单、无创且可靠的工具。
clinicaltrials.gov/ NCT07148102；于2025年8月22日注册。
• NIV广泛用于患有RDS的早产儿，但预测NIV失败仍然具有挑战性。肺部超声评分和胸腔液体含量已被探索作为NIV结局的床旁预测指标，准确性各异。• 膈肌超声参数（DTF和DE）在评估新生儿呼吸功能方面已显示出潜力。
• 通过超声测量的DTF和DE在预测NIV失败方面与通过EC获得的TFC具有很强的相关性。此外，在识别有NIV失败风险的早产儿方面，DTF和DE比TFC具有更高的预测准确性。• 早期评估DTF和DE可能作为在早产儿早期应用NIV期间监测肺功能的有价值的床旁工具。
