A Simplified, Regional Lung Ultrasound Score for Surfactant Administration in Neonatal RDS: A Prospective...

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Medical Imaging

Background:

• Total lung ultrasound score (tLUS) is established for assessing neonatal respiratory distress syndrome (RDS) progression and guiding surfactant therapy.
• tLUS is calculated from regional lung ultrasound scores (rLUS) derived from specific ultrasound views.

Purpose of the Study:

• To evaluate the individual and combined predictive contributions of rLUS to tLUS for surfactant need in RDS.
• To assess the predictive power of rLUS, tLUS, and additional clinical variables for surfactant administration in neonates.

Main Methods:

• Secondary analysis of a multicenter, prospective, observational study involving preterm neonates with RDS stabilized on nCPAP.
• Calculation of tLUS by summing six rLUS (0-3 scale) and the oxygen saturation/inspired oxygen fraction ratio (SatO2/FiO2) within 2 hours of life.
• Surfactant administration, masked to ultrasound results, served as the reference standard for predicting need.

Main Results:

• A midclavicular (MC) score ≥2 indicated early aeration heterogeneity.
• Individual left and right MC scores demonstrated high prognostic accuracy (AUCs 0.86-0.87) for surfactant need.
• A combined left + right MC score achieved an AUC of 0.90, with a prediction model including gestational age and SatO2/FiO2 reaching an AUC of 0.95.

Conclusions:

• Regional lung ultrasound scores are not uniformly distributed in early RDS.
• The combined MC score is a rapid, accurate predictor for surfactant replacement, simplifying early management.
• This approach can reduce stressful interventions for preterm neonates in the initial hours of life.