Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with respiratory support

Abstract

Background: Lung ultrasonography (LUS) has emerged as a radiation-free alternative to chest X-rays, showing promise in assessing lung aeration and guiding therapeutic decisions in neonates with respiratory distress. Despite its potential, widespread adoption of LUS requires standardized protocols and further validation against traditional imaging modalities like CXRs. Aim This study aimed to evaluate the effectiveness of Lung Ultrasonography Score (LUS) in assessing oxygenation levels and identifying the need for surfactant therapy in neonates receiving respiratory support at a Level IIB Neonatal Intensive Care Unit (NICU). Methodology: This prospective observational study was conducted from January 2021 to June 2022 at a Level IIB Neonatal Intensive Care Unit (NICU) in Karnataka, India. The study included neonates <34 weeks and >34 weeks gestational age admitted with respiratory distress, excluding those with chromosomal abnormalities or congenital lung diseases. Lung ultrasonography scores (LUS) were assessed upon admission and before surfactant administration, using a scoring system ranging from 0 to 3 across defined thoracic regions to evaluate lung aeration. Statistical analysis included correlation tests and ROC curve analysis to assess LUS's ability to predict oxygenation parameters and need for surfactant therapy. Results: A total of 75 neonates were included in the study, with mean LUS scores correlating significantly with arterial to alveolar ratios (r = -0.74, p < 0.001) and PaO2 values (r = 0.68, p < 0.001). LUS demonstrated good predictive accuracy for surfactant therapy need, with an areaunder the ROC curve of 0.85 (95% CI: 0.75-0.95). Neonates requiring surfactant therapy had significantly higher mean LUS scores compared to those managed conservatively (p < 0.001). Conclusion: These findings underscore the utility of LUS in assessing lung aeration and guiding clinical management decisions in neonates with respiratory distress, potentially enhancing early intervention strategies in NICU settings.