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Lin X, Zhang H, Wang X, Zhang R, Zhang L, You X, Xiao L, Wu C, Jiang F, Wang J. Proportion of confluent B-Lines predicts respiratory support in term infants shortly after birth. Respir Res 2024; 25:307. [PMID: 39138486 PMCID: PMC11323528 DOI: 10.1186/s12931-024-02944-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE To develop and evaluate the predictive value of a simplified lung ultrasound (LUS) method for forecasting respiratory support in term infants. METHODS This observational, prospective, diagnostic accuracy study was conducted in a tertiary academic hospital between June and December 2023. A total of 361 neonates underwent LUS examination within 1 h of birth. The proportion of each LUS sign was utilized to predict their respiratory outcomes and compared with the LUS score model. After identifying the best predictive LUS sign, simplified models were created based on different scan regions. The optimal simplified model was selected by comparing its accuracy with both the full model and the LUS score model. RESULTS After three days of follow-up, 91 infants required respiratory support, while 270 remained healthy. The proportion of confluent B-lines demonstrated high predictive accuracy for respiratory support, with an area under the curve (AUC) of 89.1% (95% confidence interval [CI]: 84.5-93.7%). The optimal simplified model involved scanning the R/L 1-4 region, yielding an AUC of 87.5% (95% CI: 82.6-92.3%). Both the full model and the optimal simplified model exhibited higher predictive accuracy compared to the LUS score model. The optimal cut-off value for the simplified model was determined to be 15.9%, with a sensitivity of 76.9% and specificity of 91.9%. CONCLUSIONS The proportion of confluent B-lines in LUS can effectively predict the need for respiratory support in term infants shortly after birth and offers greater reliability than the LUS score model.
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Affiliation(s)
- Xinao Lin
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Hehua Zhang
- Department of Neonatology, Fuyang Women and Children's Hospital, Fuyang, China
| | - Xuefeng Wang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Ruijie Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Lu Zhang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Xueqin You
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Lingling Xiao
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China
| | - Chuyan Wu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China.
| | - Jimei Wang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 128, Shenyang Rd, Yangpu District, Shanghai, 200082, China.
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Nour BA, El-Rahman AMA, Hameed SAEAE, Mohsen N, Mohamed A, El-Bayoumi MA, Abdel-Hady HE. Lung and diaphragm ultrasound as predictors of successful weaning from nasal continuous positive airway pressure in preterm infants. Pediatr Pulmonol 2024; 59:1428-1437. [PMID: 38501314 DOI: 10.1002/ppul.26933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Assessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants. STUDY DESIGN This prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP. RESULTS Out of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning. CONCLUSION LUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.
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Affiliation(s)
- Basma Ahmed Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Nada Mohsen
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | | | - Hesham Elsayed Abdel-Hady
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
- Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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