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Updated: May 21, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Lung Ultrasound and Lung Clearance Index After Preterm Birth: A Structure-Function Framework for Bronchopulmonary
Jan Neneman1, Anna Wiesner1, Dawid Szpecht2
1Department of Pediatric Pulmonology, Allergy and Clinical Immunology, Institute of Pediatrics, Poznan University of Medical Sciences, Poznan, Poland.
Insights
Lung ultrasound (LUS) and multiple-breath washout (MBW) lung clearance index (LCI) offer complementary assessments for preterm infants. A combined surveillance framework using LUS and LCI can improve tracking of respiratory disease development.
Area of Science:
- Neonatal respiratory medicine
- Pulmonary imaging and physiology
Background:
- Bronchopulmonary dysplasia (BPD) and post-prematurity respiratory disease (PPRD) result from disrupted lung development in preterm infants.
- Current diagnostic criteria based on oxygen and support needs at fixed ages do not fully capture lung injury or long-term outcomes.
Purpose of the Study:
- To review evidence on neonatal lung ultrasound (LUS) and multiple-breath washout (MBW)-derived lung clearance index (LCI) in preterm infants.
- To propose a time-dependent surveillance framework integrating LUS and LCI for PPRD.
Main Methods:
- Searched PubMed and references for BPD/PPRD definitions, LUS in neonates for BPD prediction, and MBW/LCI methodology and interpretation.
- Focused on studies evaluating LUS and LCI in the context of preterm birth and respiratory outcomes.
Main Results:
- Standardized serial LUS provides bedside structural assessment with prognostic value for BPD and potential links to later morbidity.
- LCI offers a global functional measure of ventilation inhomogeneity, detecting peripheral airway dysfunction, though infant LCI has limitations.
- LUS and LCI are complementary, stage-specific tools.
Conclusions:
- A feasible surveillance pathway involves early LUS and later MBW/LCI follow-up within PPRD frameworks.
- Prospective studies are needed to link neonatal LUS trajectories with LCI and patient outcomes.
Background:
Bronchopulmonary dysplasia (BPD) and post-prematurity respiratory disease (PPRD) are heterogeneous consequences of disrupted lung development after preterm birth. Diagnostic frameworks anchored to oxygen requirement and respiratory support at fixed postmenstrual ages incompletely capture structural injury, ventilation heterogeneity, and long-term trajectories.
Objective:
To synthesize evidence on neonatal lung ultrasound (LUS) and multiple-breath washout (MBW-derived lung clearance index (LCI) after preterm birth and to propose a pragmatic, time-dependent structure-function surveillance framework.
Methods:
Targeted, non-systematic PubMed searches and reference screening were performed for (1) BPD/PPRD definitions and guidance; (2) neonatal LUS standards, scoring systems, and cohorts evaluating BPD prediction and later morbidity; and (3) MBW/LCI methodological standards, device/method considerations, and reference equations informing interpretation across childhood and adulthood.
Results:
Serial LUS provides a repeatable bedside structural signal during the NICU course when acquisition and scoring are standardized. Early LUS trajectories, particularly within the first two postnatal weeks, show prognostic value for subsequent moderate-to-severe BPD, and modified scores may relate to later respiratory morbidity. LCI offers a complementary global functional readout of ventilation inhomogeneity, often detecting peripheral airway dysfunction during tidal breathing when spirometry is insensitive or infeasible; however, infant LCI is constrained by dead-space effects and method/device sensitivity.
Conclusions:
LUS and LCI are complementary, stage-specific tools. A pathway that anchors early surveillance in standardized LUS and extends longitudinal follow-up with MBW/LCI from preschool age onward is clinically feasible within PPRD frameworks. Prospective studies linking neonatal LUS trajectories with later LCI and patient-important outcomes are needed.
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