Comparison between lung ultrasonography and chest X-ray in the evaluation of neonatal respiratory distress syndrome

The association between antenatal indomethacin exposure and persistent pulmonary hypertension of the newborn in extremely preterm infants

The study aimed to investigate the association between antenatal indomethacin exposure and persistent pulmonary hypertension of the newborn (PPHN) in extremely preterm infants. A retrospective cohort study was conducted involving extremely preterm infants admitted from January 2022 to May 2024. Neonates were categorized into the indomethacin group and the control group based on the antenatal indomethacin exposure. The primary outcome focused on the incidence of PPHN, while secondary outcomes encompassed the incidence of moderate to severe bronchopulmonary dysplasia (BPD), mortality, respiratory distress syndrome (RDS) ≥ stage III, hemodynamically significant patent ductus arteriosus (hsPDA), spontaneous intestinal perforation (SIP), intraventricular hemorrhage (IVH) ≥ grade III, surgical necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP) ≥ stage 3. Among the 203 included neonates, there were 68 neonates in the indomethacin group and 135 neonates in the control group. A significant association was observed between antenatal indomethacin exposure and the incidence of PPHN in extremely preterm infants (OR, 6.435; 95% CI, 1.263-32.795; P = 0.031). Among the secondary outcomes, the incidence of pneumothorax in indomethacin group was higher than that in the control group (OR,10.635; 95% CI,1.217-92.94, P = 0.029). There were no significant differences between the two groups in the incidence of other secondary outcomes (P > 0.05 for all). Antenatal indomethacin exposure was found to be associated with PPHN in extremely preterm infants. Therefore, careful consideration and comprehensive assessment were necessary when using indomethacin during pregnancy. Determining the optimal timing for its administration was crucial to minimize the risk of PPHN in this vulnerable population.

The diagnostic value and efficacy evaluation of lung ultrasound score in neonatal respiratory distress syndrome: a prospective observational study

Objective

To evaluate the diagnostic efficacy and determine the optimal cut-off values of lung ultrasound score for diagnosing neonatal respiratory distress syndrome and its accuracy in assessing the efficacy of neonatal respiratory distress syndrome.

Method

This prospective study included 100 neonates with suspected neonatal respiratory distress syndrome. Each patient underwent both the 14-zone and 12-zone lung ultrasound methods, as well as a chest x-ray, performed after birth and before initiating drug treatment. Surfactant replacement therapy was administered to patients who were diagnosed with neonatal respiratory distress syndrome and met the criteria for medication. Lung ultrasound was conducted and recorded at the 24th hour, the 48th hour, the 72nd hour, and the 7th day after drug administration. ROC curve analysis, Kappa statistics, and ANOVA were utilized to identify the optimal cut-off values for the lung ultrasound scores in diagnosing neonatal respiratory distress syndrome.

Results

89 neonates were diagnosed with respiratory distress syndrome, of whom 64 received surfactant replacement therapy. The mean scores of 12-zone lung ultrasound score, 14-zone lung ultrasound score, and chest x-ray score are 18.22 ± 7.15, 38.92 ± 9.69, and 2.15 ± 0.97, respectively. The diagnostic AUC for the 12-zone lung ultrasound score is 0.84 (95% CI: 0.73-0.95), with an optimal cut-off value of 13.5 for diseased vs. not diseased, while the AUC for the 14-zone lung ultrasound score is 0.88 (95% CI: 0.76-0.99), with an optimal cut-off value of 34 for diseased vs. not diseased. There is significant concordance between the neonatal lung ultrasonography scores and the chest x-ray score for diagnosis respiratory distress syndrome (P < 0.01). The optimal cut-off values for the grading diagnosis of neonatal respiratory distress syndrome using the 14-zone lung ultrasound score are identified as 36.5, 40.5, and 44.5. The 12-zone lung ultrasound score does not have a significant difference between the 12th hour after receiving surfactant replacement therapy and the 48th hour after treatment (P = 0.08). All other comparisons demonstrated significant differences.

Conclusion

The 14-zone lung ultrasound score demonstrates higher diagnostic efficacy in diagnosing neonatal respiratory distress syndrome and can accurately evaluate the early efficacy of surfactant replacement therapy in neonates.

Predictive Value of Lung Ultrasound Scores Combined with Serum ANGPTL4 Levels on Severity and Prognosis of Neonatal Respiratory Distress Syndrome

Objective

Respiratory distress syndrome threatens neonates' life. This study probed the predictive value of lung ultrasound scores combined with serum angiopoietin-like protein 4 (ANGPTL4) levels on neonatal respiratory distress syndrome (NRDS) severity and prognosis.

Methods

The NRDS group (n = 115) and control group (n = 30) were established. In both groups, lung ultrasound scores and serum ANGPTL4 levels, lung ultrasound scores and serum ANGPTL4 levels of newborns with NRDS of different severity, the risk factors affecting the poor prognosis of NRDS neonates, and the value of serum ANGPTL4 levels combined with lung ultrasound scores in determining the severity and prognosis of newborns with NRDS were analyzed.

Results

The NRDS groups had higher lung ultrasound scores and serum ANGPTL4 levels, and lower Apgar scores than the control group; lung ultrasound scores and serum ANGPTL4 levels were higher in the moderate and severe groups than in the mild group, and those were higher in the severe group than in the moderate group (all p < 0.05). The logistic regression analysis showed that high lung ultrasound scores, and high serum ANGPTL4 levels were risk factors for NRDS poor prognosis (OR > 1, p < 0.05), and high Apgar scores are the protective factor for poor prognosis in NRDS neonates (OR < 1, p < 0.05). The area under the curve of lung ultrasound scores combined with serum ANGPTL4 levels to assess the severity and prognosis of NRDS neonates exhibited a higher assessed value than the single test.

Conclusion

Lung ultrasound scores and serum ANGPTL4 levels are closely related to the severity and prognosis of NRDS neonates, and the combination of the two improves the assessed value of the severity and prognosis of NRDS neonates. The study provided a reference for the disease severity assessment of NRDS and the prediction of its prognosis.

Setting the Standards: Neonatal Lung Ultrasound in Clinical Practice

The use of lung ultrasonography in neonates is increasing at a very fast rate. Evidence-based guidelines on the use of lung ultrasound (LU) in neonates and children have been published and well received across the world. However, there remains a lack of standardized curriculum for lung ultrasound training and standards for its application at the bedside. This article focuses on providing a standardized approach to the application of lung ultrasonography in neonates for the common neonatal conditions and how it can be integrated into bedside clinical decision-making.

Diagnostic Potentials of Lung Ultrasound In Neonatal Care: An Updated Overview

Recent technological strides, including high-frequency probes and lung ultrasound, have become a crucial non-invasive diagnostic tool in neonatal care, revolutionizing how respiratory conditions are assessed in the neonatal intensive care unit (NICU). High-frequency probes and portable devices significantly enhance the effectiveness of lung ultrasound in identifying respiratory distress syndrome (RDS), pneumonia, and pneumothorax, and underscore its growing significance. This comprehensive review explores the historical journey of lung ultrasonography, technological advancements, contemporary applications in neonatal care, emerging trends, and collaborative initiatives, and foresees a future where personalized healthcare optimizes outcomes for neonates.

Neonatal point-of-care lung ultrasound: what should be known and done out of the NICU?

Lung ultrasound is rapidly becoming a useful tool in the care of neonates: its ease of use, reproducibility, low cost, and negligible side effects make it a very suitable tool for the respiratory care of all neonates. This technique has been extensively studied by different approaches in neonatal intensive care unit (NICU), both for diagnostic and prognostic aims and to guide respiratory treatments. However, many neonates are being born in level I/II hospitals without NICU facilities so all pediatricians, not just neonatal intensivists, should be aware of its potential. This is made possible by the increasing access to ultrasound machines in a modern hospital setting. In this review, we describe the ultrasonographic characteristics of the normal neonatal lung. We also discuss the ultrasound features of main neonatal respiratory diseases: transient tachypnea of the neonate (TTN), respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), pneumothorax (PNX), pleural effusion (PE), or pneumonia. Finally, we mention two functional approaches to lung ultrasound: 1. The use of lung ultrasound in level I delivery centers as a mean to assess the severity of neonatal respiratory distress and request a transport to a higher degree structure in a timely fashion. 2. The prognostic accuracy of lung ultrasound for early and targeted surfactant replacement.

CONCLUSION

 LU is still a useful tool in level I/II neonatal units, both for diagnostic and functional issues.

WHAT IS KNOWN

• Neonatal lung ultrasound has been recently introduced in the usual care in many Neonatal Intensive Care Units.

WHAT IS NEW

• It also has many advantages in level I/II neonatal units, both for neonatologist or even pediatricians that treat neonates in those sites.

Classification of lung pathologies in neonates using dual-tree complex wavelet transform

INTRODUCTION

Undiagnosed and untreated lung pathologies are among the leading causes of neonatal deaths in developing countries. Lung Ultrasound (LUS) has been widely accepted as a diagnostic tool for neonatal lung pathologies due to its affordability, portability, and safety. However, healthcare institutions in developing countries lack well-trained clinicians to interpret LUS images, which limits the use of LUS, especially in remote areas. An automated point-of-care tool that could screen and capture LUS morphologies associated with neonatal lung pathologies could aid in rapid and accurate diagnosis.

METHODS

We propose a framework for classifying the six most common neonatal lung pathologies using spatially localized line and texture patterns extracted via 2D dual-tree complex wavelet transform (DTCWT). We acquired 1550 LUS images from 42 neonates with varying numbers of lung pathologies. Furthermore, we balanced our data set to avoid bias towards a pathology class.

RESULTS

Using DTCWT and clinical features as inputs to a linear discriminant analysis (LDA), our approach achieved a per-image cross-validated classification accuracy of 74.39% for the imbalanced data set. Our classification accuracy improved to 92.78% after balancing our data set. Moreover, our proposed framework achieved a maximum per-subject cross-validated classification accuracy of 64.97% with an imbalanced data set while using a balanced data set improves its classification accuracy up to 81.53%.

CONCLUSION

Our work could aid in automating the diagnosis of lung pathologies among neonates using LUS. Rapid and accurate diagnosis of lung pathologies could help to decrease neonatal deaths in healthcare institutions that lack well-trained clinicians, especially in developing countries.