Thoracic fluid content by electric cardiometry versus lung ultrasound in preterm neonates with respiratory distress: A prospective study

Abstract

Background

Respiratory distress (RD) is a major cause of admission to neonatal intensive care units (NICUs), highlighting the need for prompt and accurate assessment. Lung ultrasound (LUS) has emerged as a rapid, non-invasive, radiation-free tool with superior sensitivity to chest X-ray. Thoracic Fluid Content (TFC), measured via electrical cardiometry, may serve as a complementary parameter by reflecting pulmonary fluid load. Consequently, this study aimed to evaluate the predictive accuracy of TFC and LUS in determining the need for surfactant therapy or initiation of positive pressure ventilation in preterm neonates with respiratory distress.

Patients and Methods

In this prospective observational cohort study, 70 preterm neonates with RD were enrolled between April 2022 and April 2024 in the NICU of Ain Shams University, Cairo, Egypt. LUS and TFC were measured on day 1 and day 3 of life. Clinical outcomes, including surfactant need and escalation of ventilation, were recorded.

Results

An LUS score >5 strongly predicted surfactant need, showing 88.89% sensitivity and 86.05% specificity (AUC: 0.941; PPV: 80%; NPV: 92.5%). TFC values were higher in neonates who received surfactant, though not statistically significant (p = 0.053). A significant positive correlation was observed between TFC and LUS scores (r = 0.311, p = 0.009).

Conclusion

LUS is a reliable predictor of surfactant need and respiratory support in preterm neonates with RD. While TFC correlates with LUS in assessing pulmonary fluid status, it alone did not independently predict clinical intervention requirements.