Lung Ultrasound Score as a Predictor for Extubation Failure in Preterm Infants

Extubation in preterm infants is a complex decision, and clinicians need to balance the risk of respiratory failure with the potential benefits of reducing mechanical ventilation. Lung ultrasound Score (LUS) has emerged as a promising tool to assist in this decision-making process. This study aimed to evaluate the predictive value of LUS score for successful extubation in preterm infants born < 35 weeks gestation.

This is a prospective, observational study that was conducted on 77 preterm infants with gestational age < 35 weeks who were supported by invasive mechanical ventilation due to respiratory distress syndrome (RDS). LUS was performed within 2 h before extubation and LUS score was calculated, receiver operating characteristic analysis (AUC) was done to get cut-off score, sensitivity, and specificity.

Sixty-six babies (85.7%) were successfully extubated (ES) to noninvasive respiratory support while 11 babies (14.2%) failed extubation (EF) within the 72 h period from the onset of extubation. Pre-extubation LUS score was significantly higher (7.0 ± 2.75) in EF group compared to neonates in ES group (4.89 ± 1.81) with p < 0.05 (0.028). A cut-off LUS score > 6 had a sensitivity 78.5% and a specificity 67.7% (95% confidence interval: 0.67-0.89) to predict extubation failure. Positive predictive value (PPV) was 63.3%, and negative predictive value (NPV) was 75%. The gestational age (GA) was 31.51 ± 2.9 in (ES) versus 29.90 ± 3.2 weeks in (EF) with no significant difference between both groups as well as birth weight (1661 ± 590 g vs. 1411 ± 47 g). Male sex represented 66% of the studied cohort.

LUS score offers a modest predictive value for successful extubation in mechanically ventilated preterm infants. However, Its ease of use and real-time assessment make it a valuable addition to the clinical decision-making process in managing these fragile infants.