A Refined Score, Namely Thoracic Ultrasound Score, to Predict the Need for Surfactant in Preterm Neonates: A Prospective, Multicenter, Observational Study.
Carlo Alberto Forcellini, Sara Rossignoli, Benjamim Ficial, Giorgia Cenci, Leonardo Santoro, Luca Bonadies, Enrico Franchetti, Francesca Vallortigara, Veronica Mardegan, Luca Vecchiato, Massimo Scollo, Lorenzo Zanetto, Stefania Vedovato, Nicola Tsatsaris, Luigi Cattarossi, Renzo Beghini, Angelo Pietrobelli
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Abstract
Introduction: Lung ultrasound score (LUS) is used to predict the need for surfactant in preterm neonates. Its performance is lower in neonates with a gestational age (GA) ≥ 34 weeks. We developed a score, thoracic ultrasound score (TUS), to overcome the shortcomings of LUS.
Objectives: To assess the feasibility and diagnostic accuracy of TUS to evaluate oxygenation and predict the need for surfactant administration, compared to LUS.
Materials and methods: This was a prospective, multicenter, observational study. Preterm neonates in noninvasive ventilation with GA between 24 + 0 and 36 + 6 weeks were assessed for eligibility. Lung ultrasound were performed within 3 h of life, and TUS and LUS were calculated.
Results: Fifty-eight neonates who received surfactant were compared with 112 neonates who did not receive surfactant: GA 30.2 ± 3.1 weeks versus 32.6 ± 2.3 weeks, (p < 0.001), and birth weight 1466 ± 674 g versus 1725 ± 519 g, (p = 0.006), respectively. TUS and LUS showed a similar association with S/F ratio (r = -0.670 and r = 0.615) and OSI (r = 0.524 and r = 0.423), all p < 0.001. In neonates with GA < 34 weeks, the AUC (95% CI) was similar: 0.956 (0.923-0.989) versus 0.952 (0.921-0.984). In neonates with GA ≥ 34 weeks, the AUC (95% CI) of TUS was superior to LUS: 0.971 (0.914-1.000) versus 0.797 (0.639-0.980), p = 0.02.
Conclusion: Compared to LUS, TUS showed a similar association with the oxygenation status and a superior ability to predict the need for surfactant in neonates with GA ≥ 34 weeks. The latter was similar in neonates with GA < 34 weeks.
期刊介绍：
Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases.
PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.
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