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Abstract

Objective:

The study was conducted to determine the value of various lung ultrasonography (LUS) findings in diagnosing neonatal respiratory distress syndrome (RDS) and to assess the ability of ultrasonography to predict the need for surfactant treatment.

Materials and Methods:

This cohort study was conducted on 164 neonates with RDS with a gestational age of over 28 weeks. Transthoracic sonography was performed in all patients in the infant isolet immediately after admission and stabilization of the infant and during the first 6 hours before surfactant treatment. Immediately after the sonogram, the neonates underwent an anterior–posterior view chest radiograph, before and after surfactant treatment.

Results:

In comparison with clinical manifestations and radiographic findings as the references, the sensitivity and specificity of each of the LUS-related parameters for detecting RDS were as follows: Faded A-lines (95.4% and 76.7%), abnormal B-lines (91.7% and 71.6%), the presence of consolidation (90.9% and 88.3%), the presence of pleural effusion (95% and 86.7%), and alveolar–interstitial syndrome (AIS) (98% and 96%).

Conclusion:

LUS findings were valuable in assessing and grading the severity of neonatal RDS alongside clinical evaluation. LUS may assist in selecting infants for surfactant therapy and monitoring treatment response.

Keywords

lung ultrasonography chest radiography respiratory distress syndrome

Respiratory distress syndrome (RDS), formerly known as hyaline membrane disease, is a common cause of death and complications in premature neonates. Preterm labor accounts for about 8% to 10% of all deliveries, and preterm birth accounts for about 60 to 80% of worldwide deaths and morbidity in neonates without congenital anomalies.^1
–5 One of the most important morbidities due to prematurity is respiratory problems, headed by RDS.^6
–8 RDS is a type of pulmonary developmental defect commonly seen with preterm labor and caused by a surfactant deficiency. Pulmonary surfactant deficiency leads to extensive atelectasis, residual lung capacity loss, and ventilation-to-perfusion ratio disturbance. The consequences of this condition are the weakness of the respiratory muscles and decreased pulmonary compliance, which is associated with decreased oxygenation, cyanosis, respiratory and metabolic acidosis, increased pulmonary vascular resistance, and right-to-left shunt through the ductus arteriosus. The prominent radiological findings include pronounced hypoaeration, bilateral fine granular opacities in the pulmonary parenchyma, and peripherally extending air bronchograms. In severe cases, extensive atelectasis and complete lung opacity (white lung) are seen.^9
–14

In the last two decades, significant progress has been made in using ultrasonography in pediatrics, especially in assessing the developmental status of the fetus and infant.¹⁵ This method has been very popular because it is less expensive, easily accessible, and noninvasive. However, based on previous studies, different sensitivities and specificities have been reported for sonography in the evaluation of neonatal lungs, which might be caused by various physiological and pathological factors.^16
–19 This role has been particularly prominent in the assessment of neonatal respiratory disorders. Accordingly, various criteria have been proposed and interpreted to assess the rate of neonatal lung development.^20,21 In general, pulmonary sonography has made it possible to assess the natural alveolar bed of the lung quickly and accurately and to distinguish between the alveolar and interstitial patterns of involvement of the lung.^22
–25 Ultrasonography can aid in describing a neonates’ respiratory problems, including evaluation of meconium aspiration syndrome, RDS, TTN (transient tachypnea of neonates), and pneumothorax. Given that patients with RDS can benefit from treatment with continuous positive airway pressure (CPAP) and administration of selective surfactant, it is obvious that the changes in pulmonary function resulting from these treatments would be consistent with ultrasonography findings.^26,27 There has also been evidence of the use of ultrasonic-based scoring systems to assess the need for surfactant administration in infants with RDS.²⁸ Based on the evaluations, the neonatal lung ultrasonography score correlated with pulmonary function indicators such as oxygenation. However, it has been understood that lung ultrasonography scores’ ability to predict response to treatment and the need for surfactant administration in infants with RDS has been highly dependent on various factors, such as gestational age.^29
–31

Various studies have been performed regarding the value of ultrasonography in diagnosing neonatal RDS, and the diagnostic value has been reported as high for this purpose.^32
–34 In a recent meta-analysis, the total evidence indicated a sensitivity of 92% (in the range of 89 to 94%) and a specificity of 95% (in the range of 93 to 97%) for ultrasonography in the diagnosis of RDS.⁸ However, few studies have individually assessed the diagnostic value of each lung ultrasonography’s findings in neonates with RDS.

In this regard, the aim was to determine the sensitivity and specificity of each ultrasonography-related parameter for detecting RDS and the need for receiving surfactant considering the clinical manifestations and radiographic findings, as the references.

Materials and Methods

Patients

This cohort study was conducted on 164 neonates with RDS who were admitted to a teaching hospital’s neonatal intensive care unit in Tehran from April 2016 to July 2022. The study has received ethical approval from the Ethics Committee of Shahid Beheshti University of Medical Sciences with the IRB number (IR.SBMU.MSP.REC.1398.357). Before enrolling the neonates into the study, the study was discussed with the parents, and written informed consent was obtained from them. The inclusion criteria were (1) gestational age of at least 28 weeks at birth, (2) infants with the following symptoms during the first 24 hours after birth: high respiratory rate 60 times per minute, intercostal or sub-rib retraction, granting, or nasal flaring.

In this regard, the neonates who were intubated in the operating room immediately after birth due to respiratory distress and underwent surfactant therapy, those with congenital or cardiovascular abnormalities, or congenital lung disease, patients who were discharged or died before completing both chest radiography and ultrasonography, patients who developed dyspnea solely due to severe infectious agents and meconium aspiration syndrome were all excluded.

Considering the fraction of inspiratory oxygen (FIO2), neonates with RDS were classified into two groups with and without the need for surfactant, the ones who required assisted ventilation with a fraction of FIO2 higher than 0.3 were categorized in the group with the need for receiving surfactant (200 mg/kg of poractant, through the intubation–surfactant–extubation technique) and others were categorized in the group without the need for surfactant therapy. The study relied on the European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update for guidance and reference.³⁵

Lung Ultrasonography Protocol

Transthoracic ultrasonography was performed in all patients with a SonoSite M-turbo portable ultrasound device with a linear array transducer at a frequency of 7.5 MHz. Patients were examined by a radiologist with 10 years of experience in doing pediatric ultrasonography. Ultrasonography was completed on the neonate bedside immediately after admission and stabilization of the infant and during the first 6 hours before surfactant treatment.^4,14

Transthoracic lung ultrasonography (LUS) was performed with longitudinal views on the anterior and posterior walls of the chest. Bilateral upper anterior, lower anterior, upper posterior, and lower posterior chest images were obtained. LUS images were stored digitally.

Suggested findings of RDS on LUS were as follows (see Figures 1 –4):

A gradual fading to disappearance of the normal A-lines, which are unrealistic echogenic images of the pleural line seen in parallel and at equal distances from the top of the examination site to the edge of the site.

Appearance of the unusual B-lines, which are unrealistic hyperechoic images that look like a column from the pleural line to the edge of the examination site.

Lung consolidation is defined as the similarity of lung tissue to liver tissue, sometimes referred to as hepatization, and contains air bronchogram images.

B-line pattern or alveolar–interstitial syndrome (AIS) during an LUS as more than 3 B-lines are seen in the images, or a white lung is seen in the examined area. It is also known as a severe B-pattern if it is large and compacted.

Pleural effusion (fluid accumulation in the space between the diaphragm and the pleura).

Bilateral white lung is the presence of many B-lines in 6 lung regions without horizontal reverberation.³⁶

Figure 1.

(A) A chest radiograph of a 28-week gestational age neonate demonstrated the diffuse ground glass opacities bilaterally accompanied by blunt left costophrenic angle (see white arrow) consistent with respiratory distress syndrome and left pleural effusion. (B) The lung sonographic image, of the same neonate, shows pleural effusion (see white arrow) and atelectasis of the lung.

Figure 2.

(A) A chest radiograph of a 30-week gestational age neonate demonstrated the diffuse ground glass opacities bilaterally and the appearance of the white lung in the upper zone of the right lung consistent with respiratory distress syndrome. (B) The lung sonographic image, of the same neonate, shows the disappearance of A-lines and the presence of B-lines (see white arrows).

Figure 3.

(A) A chest radiograph of a 29-week gestational age neonate exhibited diffuse fine reticular opacities consistent with respiratory distress syndrome. (B) The lung sonographic image, of the same neonate, shows the fading of A-lines along with the presence of B-lines (see white arrows).

Figure 4.

(A) A chest radiograph of a 31-week gestational age neonate demonstrated the diffuse ground glass opacities and air bronchogram bilaterally in favor of respiratory distress syndrome. (B) The lung sonographic image of the same neonate shows the fading of A-lines along with the presence of B-lines (see white arrows).

Chest Radiography Protocol

Immediately after the LUS, the neonates underwent an anterior–posterior view chest radiograph (CXR), before and after the possible need for surfactant treatment. Before including the CXR images in the study, a second radiologist, with 5 years of experience reporting pediatric chest imaging, conducted a thorough assessment. Only the radiographic images of high quality were included. Then the CXRs were interpreted by a third radiologist with 8 years of experience in reporting pediatric chest imaging. This radiologist was asked to review the two groups of neonates with and without the need for receiving surfactant, after anonymization. The typical CXR diagnostic findings that suggest RDS are hypoexpansion, fine and scattered granular densities, air bronchogram, ground glass opacity, or white lungs.

Statistical Analysis

For data analysis, results were presented as mean ± standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Continuous variables were compared using the t-test or Mann-Whitney U test whenever the data did not appear to have normal distribution or when the assumption of equal variances was violated across the study groups. In this regard, the best cut-off value and the sensitivity and specificity of this cut-off point were also determined. P-values of ≤.05 were considered statistically significant. The statistical software SPSS version 23.0 for Windows (IBM, Armonk, New York) was used for the statistical analysis.

Results

In this study, 66 neonates with RDS needed surfactant administration and 98 neonates with RDS, without the requirement of surfactant administration, were included. Demographic and clinical details are shown in Table 1. 71(43%) neonates were at the gestational age of 28 to 30 weeks, and 93(57%) were at 30 to 32 weeks of age. The average birth weight of newborns was estimated to be 1857 ± 803 g. 103 (63%) of neonates were male. 26(16%) of cases had a history of fetal growth retardation. 50(31%) of neonates were given birth vaginally (see Table 1).

Table 1.

The Demographic and Clinical Information on the Cohort of Neonates, Based on Their Gestational Age at Birth.

	Total	28–30 Weeks	30–32 Weeks
N	164	71 (43%)	93 (57%)
Weight (g)	1857 ± 803	1155 ± 221	1623 ± 591
Gender, male (%)	103 (63%)	58 (56%)	45 (43%)
Fetal growth restriction	26 (16%)	15 (57%)	11 (42%)
Vaginal birth	50 (31%)	22 (44%)	28 (56%)

In the evaluation of the CXR, in total, 152 cases (93%) had an abnormality in their radiographs, including 122 cases (74.3%) with fine reticular opacity, 33 cases (20%) with ground glass opacity, and 9 cases (5%) had white lungs (see Table 2).

Table 2.

Comparison of Chest Radiographic Findings, in Neonates of a GA of 28–30 Weeks and 30–32 Weeks.

Chest Radiographic Findings	GA: 28–30 Weeks; Percent of the Cohort	GA: 30–32 Weeks; Percent of the Cohort	Total	P-value
A fine reticular radiographic opacity	98 (59%)	24 (14%)	122 (74.3%)	.05
A ground glass radiographic opacity	25 (15%)	8 (4%)	33 (20%)	.06
The “white lung” radiographic artifact	7 (4%)	2 (1%)	9 (5%)	.04

Abbreviation: GA, gestational age.

For the neonatal LUS, the diagnostic findings were as follows:

The disappearance of the A-line in 66 cases (40.2%) in the right lung and 41 cases (25.6%) in the left lung.

Unusual B-lines in the right lung in 67 cases (41.5%) and the left lung in 63 cases (39%).

A consolidation in the right lung in 39 cases (24.4%) and the left lung in 37 cases (23.2%).

The presence of a pleural effusion, in the right lung, in 5 cases (3%) and the left lung in 4 cases (2.4%).

AIS was reported in the right lung in 16 cases (9.8%) and the left lung in 23 cases (14.6%) (see Table 3).

Table 3.

A Comparison of Lung Sonographic Findings in Neonates in Neonates of a GA of 28–30 Weeks and 30–32 WEEKS.

Lung Sonographic Findings	GA: 28–30 Weeks; Percent of the Cohort	GA: 30–32 Weeks; Percent of the Cohort	Total	P-value
Disappearance of the A-line (right lung)	56 (34%)	10 (6%)	66 (40.2%)	.02
Disappearance of the A-line (left lung)	35 (21%)	6 (3%)	41 (25.6%)	.02
Unusual B-lines (right lung)	51 (31%)	16 (9%)	67 (41.5%)	.03
Unusual B-lines (left lung)	48 (29%)	15 (9%)	63 (39%)	.02
Consolidation (right lung)	28 (17%)	11 (6%)	39 (24.4%)	.03
Consolidation (left lung)	32 (19%)	5 (3%)	37 (23.2%)	.06
Pleural effusion (right)	3 (1%)	2 (1%)	5 (3%)	.08
Pleural effusion (left)	2 (1%)	2 (1%)	4 (2.4%)	.07
Alveolar–interstitial syndrome (right lung)	10 (6%)	6 (3%)	16 (9.8%)	.06
Alveolar–interstitial syndrome (left lung)	17 (10%)	6 (3%)	23 (14.6%)	.04

Abbreviation: GA, gestational age.

In comparison with clinical manifestations and radiographic findings as the references, the sensitivity and specificity of each of the parameters related to LUS were as follows: faded A-lines (95.4% and 76.7%), abnormal B-lines (91.7% and 71.6%), the presence of consolidation (90.9% and 88.3%), the presence of pleural effusion (95% and 86.7%), and AIS (98% and 96%) (see Table 4).

Table 4.

The Reliability of the Lung Sonographic Findings in This Cohort of Neonates With Respiratory Distress Syndrome.

Lung Sonographic Diagnostic Findings	Percent Sensitivity(95% Confidence Interval)	Percent Specificity(95% Confidence Interval)	Percent Positive Predictive Value (95% Confidence Interval)	Percent Negative Predictive Value (95% Confidence Interval)
Faded A-lines	95.4% (78–98)	76.7% (68–84)	93% (87–96)	90% (81–94)
Abnormal B-lines	91.7% (86–97)	71.6% (69–79)	90% (83–95)	88% (82–94)
Lung Consolidation	90.9% (83–96)	88.3% (83–94)	92% (86–95)	83% (78–91)
Pleural effusion	95% (92–97)	86.7% (82–93)	91% (81–94)	89% (84–93)
Alveolar–interstitial syndrome	98% (94–99)	96% (93–98)	87% (83–94)	85% (81–89)

A total of 66 cases (40%) underwent surfactant therapy. Comparing the two groups of neonates with and without the need for surfactant treatment (see Figure 5), significantly more prevalence of A-lines (P = .005), abnormal B-lines (P = .009), consolidation (P = .004), pleural effusion (P = .002), and AIS (P = .001) were revealed in those requiring surfactant therapy.

Figure 5.

The lung ultrasonographic findings in neonates with respiratory distress syndrome comparing with and without required surfactant therapy. AIS, alveolar–interstitial syndrome.

Discussion

The role of imaging in assessing various diseases is well-known.^37
–45 As a result of the important clinical consequences of neonatal respiratory distress and the need to evaluate and diagnose its severity and extent, various diagnostic tools, such as radiographic evaluations, have always been considered. Recently, the use of LUS in assessing the extent of pulmonary involvement has been considered, and specific imaging findings have been identified for this syndrome. However, there is still a controversy about whether such diagnostic tools can help clinicians decide on treatment protocols such as surfactant therapy. The aim of the present study was the evaluation of the LUS findings of neonates with RDS and to assess the value of this tool in predicting the extent of the disease. Second, it was important to test the hypothesis of whether using these sonographic parameters could be effective in choosing surfactant as a therapeutic option. In the first phase of the assessment, the LUS findings were examined to determine whether the results were associated with RDS. In this cohort, there was a significant impact but not all of the neonates with RDS had these types of sonographic findings, including A-line blurring, abnormal B-line, a degree of condensation or pleural effusion as well as the appearance of AIS. The second important point was the high agreement between the LUS findings and the CXR findings in neonates with RDS, so each of mentioned sonographic parameters was able to diagnose RDS compared to the radiographic findings with high sensitivity, specificity, and accuracy. Therefore, due to some contraindications in the use of radiography, the use of LUS in estimating the incidence and severity of RDS in neonates could be considered very useful. Also, in the final stage of the study and by comparing the frequency of LUS symptoms in infants with and without the need for surfactant, it was noted that there was a significant difference in the incidence of these sonographic findings between the two groups of infants. In short, these symptoms can also be very helpful in suggesting neonates, with RDS, for surfactant therapy. Of course, judgments about the usefulness of this diagnostic tool in selecting neonates for this treatment protocol will rely on the results and clinical consequences of treatment in infants who are monitored and provided clinical surveillance, which should be evaluated in future studies.

In general, evaluation of these LUS findings in neonates, with suspected RDS and conjunction with clinical findings, can assist physicians with diagnosing RDS and treatment with surfactant. Almost all similar studies have emphasized the accuracy and efficiency of LUS for this purpose. In the study by Lovrenski,⁴⁶ out of 47 cases of RDS, 45 of them showed similar results and findings with CXR and LUS, which indicated the reliability of this diagnostic method in preterm neonates with RDS. In the study of Ahuja et al., LUS had a sensitivity of 85.7% and a specificity of 75% for diagnosing RDS, which was very similar to the current study findings. However, they eventually concluded that LUS could be used as a complementary method to CXR in the diagnosis of RDS. It is important to note that this diagnostic choice can be used to predict early bronchopulmonary dysplasia (BPD) and reduce the cumulative radiation dose in these neonates.^47,48 In the study of Oktem et al.,⁴⁹ it was shown that the use of LUS was a safe and accessible diagnostic technique at the patient’s bedside and could determine the response to treatment of patients with RDS to surfactant in the early stages of the disease, as well as determine neonates requiring re-treatment. However, the advantage of their study was the serial evaluation of changes in sonographic symptoms after surfactant therapy. In the study of Liu et al.,⁵⁰ it was also shown that the simultaneous presentation of pulmonary density, abnormal pleural lines, and the disappearance of A-lines was associated with 100% sensitivity and specificity in diagnosis. In addition, lung pulses had a sensitivity of 80% and a specificity of 100% in diagnosing neonatal RDS, which again emphasized the value of LUS in evaluating RDS. These works underscore the high diagnostic value of LUS, along with its low cost, low side effects, and high diagnostic ability to be performed at the patient’s bedside, which makes it an ideal choice predicting the admission to the neonatal intensive care unit. But there are still many questions that remain unanswered about whether LUS can diagnose RDS alone, whether it can determine RDS severity, and whether it can determine the therapeutic response to the surfactant.

Limitations

This study has limitations and chiefly these are due to the research design and the convenient sample of patients examined. While the study comprises a large cohort and adds scientific evidence, it is important to note that generalizations cannot be made. It is important to further underscore that this study did not include a control group. Therefore, conducting a study with a control group would be beneficial in determining the incidence of LUS abnormalities in neonates without respiratory distress syndrome (RDS). This type of experimental design, conducted as a clinical study, would yield higher levels of evidence. In addition, these results demonstrated the descriptive nature of LUS and CXR findings, but additional studies are needed to employ specific grading systems related to this objective.

Conclusion

In conclusion, this cohort study of LUS findings and their clinical evaluations demonstrate the potential value in evaluating RDS severity, in neonates. Evaluation of LUS findings can also help select neonates for surfactant therapy and assess their response to treatment. Therefore, due to some well-known contraindications with pediatric radiography, LUS could be a useful diagnostic method for detecting RDS and its severity.

Footnotes

Ethics Approval

Ethical approval for this study was obtained from the Ethics Committee of Shahid Beheshti University of Medical Sciences with the IRB number (IR.SBMU.MSP.REC.1398.357).

Informed Consent

Before enrolling the neonates into the study, the study was discussed with the parents, and written informed consent was obtained from them.

Animal Welfare

Guidelines for humane animal treatment did not apply to the present study.

Trial Registration

Not applicable.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Neda Akhoundi

References

Gale

Gelman

: Respiratory distress syndrome. Harefuah 1974;87(9):387–390.

Clements

Avery

: Lung surfactant and neonatal respiratory distress syndrome. Am J Respir Crit Care Med 1998;157(4):59–66.

Beitler

Thompson

Baron

, et al: Advancing precision medicine for acute respiratory distress syndrome. Lancet Respir Med 2021;23:2213–2600.

Cattarossi

Copetti

Brusa

Pintaldi

: Lung ultrasound diagnostic accuracy in neonatal pneumothorax. Can Respir J 2016;2016: 6515069.

Fernández

Hernández

Guerediaga

, et al: Usefulness of lung ultrasound in the diagnosis and follow-up of respiratory diseases in neonates. An Pediatr (Engl Ed) 2022;96(3):252.e1–252.e13.

Capasso

Pacella

Migliaro

De Luca

Raimondi

: Can lung ultrasound score accurately predict the need for surfactant replacement in preterm neonates? a systematic review and meta-analysis protocol. PLoS ONE 2021;16(7):e0255332.

Shin

Yoon

Lim

, et al: Pulmonary surfactant replacement therapy for respiratory distress syndrome in neonates: a nationwide epidemiological study in Korea. J Korean Med Sci 2020;35(32):e253. doi:10.3346/jkms.2020.35.e253.

Corsini

Parri

Ficial

Dani

: Lung ultrasound in the neonatal intensive care unit: review of the literature and future perspectives. Pediatr Pulmonol 2020;55(7):1550–1562.

Lamichhane

Panthee

Gurung

: Clinical profile of neonates with respiratory distress in a tertiary care hospital. JNMA J Nepal Med Assoc 2019;57(220):412–415. doi:10.31729/jnma.4770.

10.

Liszewski

Stanescu

Phillips

Lee

: Respiratory distress in neonates: underlying causes and current imaging assessment. Radiol Clin North Am 2017;55(4):629–644. doi:10.1016/j.rcl.2017.02.006.

11.

Hiles

Culpan

Watts

Munyombwe

Wolstenhulme

: Neonatal respiratory distress syndrome: chest X-ray or lung ultrasound? a systematic review. Ultrasound 2017;25(2):80–91.

12.

Corsini

Parri

Gozzini

, et al: Lung ultrasound for the differential diagnosis of respiratory distress in neonates. Neonatology 2019;115(1):77–84.

13.

Raimondi

Rodriguez Fanjul

Aversa

, et al: Lung ultrasound for diagnosing pneumothorax in the critically ill neonate. J Pediatr 2016;175:74–78.

14.

Loi

Casiraghi

Catozzi

, et al: Lung ultrasound features and relationships with respiratory mechanics of evolving BPD in preterm rabbits and human neonates. J Appl Physiol 2021;131(3):895–904.

15.

Piastra

Yousef

Brat

Manzoni

Mokhtari

De Luca

: Lung ultrasound findings in meconium aspiration syndrome. Early Hum Dev 2014;90(suppl 2):S41–S43.

16.

Oktem

Yigit

Oğuz

Celik

Haliloğlu

Yurdakok

: Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns. J Matern Fetal Neonatal Med 2021;34(2):281–286. doi:10.1080/14767058.2019.1605350.

17.

Kurepa

Zaghloul

Watkins

Liu

: Neonatal lung ultrasound exam guidelines. J Perinatol 2018;38(1):11–22.

18.

Lichtenstein

Mauriat

: Lung ultrasound in the critically ill neonate. Curr Pediatr Rev 2012;8(3):217–223.

19.

Cattarossi

: Lung ultrasound: its role in neonatology and pediatrics. Early Hum Dev 2013;89(suppl 1):S17–S19.

20.

Lobo

: The neonatal chest. Eur J Radiol 2006;60(2):152–158. doi:10.1016/j.ejrad.2006.07.018.

21.

Liu

Copetti

Sorantin

, et al: Protocol and guidelines for point-of-care lung ultrasound in diagnosing neonatal pulmonary diseases based on international expert consensus. J Vis Exp 2019;145:e58990.

22.

Roberts

Badgery-Parker

Algert

Bowen

Nassar

: Trends in use of neonatal CPAP: a population-based study. BMC Pediatr 2011;11:89.

23.

De Martino

Yousef

Ben-Ammar

Raimondi

Shankar-Aguilera

De Luca

: Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics 2018;142(3):e20180463.

24.

Aichhorn

Küng

Habrina

, et al: The role of lung ultrasound in the management of the critically ill neonate—a narrative review and practical guide. Children 2021;8(8):628.

25.

Fei

Lin

Yuan

: Lung ultrasound, a better choice for neonatal pneumothorax: a systematic review and meta-analysis. Ultrasound Med Biol 2021;47(3):359–369.

26.

Machado

Fiori

Baldisserotto

Ramos Garcia

Vieira

Fiori

: Surfactant deficiency in transient tachypnea of the newborn. J Pediatr 2011;159(5):750–754.

27.

Schmölzer

Kumar

Pichler

Aziz

O’Reilly

Cheung

: Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 2013;347:f5980.

28.

Raimondi

Migliaro

Sodano

, et al: Use of neonatal chest ultrasound to predict noninvasive ventilation failure. Pediatrics 2014;134(4):e1089–e1094.

29.

Via

Storti

Gulati

Neri

Mojoli

Braschi

: Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 2012;78(11):1282–1296.

30.

Liu

Lovrenski

Ye Hlaing

Kurepa

: Neonatal lung diseases: lung ultrasound or chest x-ray. J Matern Fetal Neonatal Med 2021;34(7):1177–1182.

31.

Liu

Guo

Kurepa

, et al: Specification and guideline for technical aspects and scanning parameter settings of neonatal lung ultrasound examination. J Matern Fetal Neonatal Med 2022;35(5):1003–1016.

32.

Yan

Liu

: Diagnostic value of lung ultrasound for neonatal respiratory distress syndrome: a meta-analysis and systematic review. Med Ultrason 2020;22(3):325–333. doi:10.11152/mu-2485.

33.

Rodríguez-Fanjul

Balcells

Aldecoa-Bilbao

Moreno

Iriondo

: Lung ultrasound as a predictor of mechanical ventilation in neonates older than 32 weeks. Neonatology 2016;110(3):198–203.

34.

Wang

Zhao

Wang

: Lung ultrasound for the diagnosis of neonatal respiratory distress syndrome: a meta-analysis. Ultrasound Q 2020;36(2):102–110.

35.

Sweet

Carnielli

Greisen

, et al: European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology 2023;120(1):3–23. doi:10.1159/000528914.

36.

Bhoil

Ahluwalia

Chopra

Surya

Bhoil

: Signs and lines in lung ultrasound. J Ultrason 2021;21(86):e225–e233.

37.

Paraham

: An investigation of the relationship between vitamin D deficiency and carotid intima-media thickness (IMT) in patients with type 1 diabetes. J Pharm Negat Results 2022;13:8033–8039.

38.

Akhoundi

Bozchelouei

Abrishami

, et al: Comparison of MRI and endoanal ultrasound in assessing intersphincteric, transsphincteric, and suprasphincteric perianal fistula [published online ahead of print April 11, 2023]. J Ultrasound Med. doi:10.1002/jum.16225.

39.

Akhoundi

Rezazadeh

Siami

Komijani Bozchelouei

Ramezani

Nosrati

: The comparison of pulsatility index, resistance index, and diameter of the temporal, carotid, and vertebral arteries during active migraine headaches to non-headache intervals [published online ahead of print May 10, 2023]. J Diagn Med Sonogr. doi:10.1177/87564793231165512.

40.

Nosrati

Akhoundi

Ahmadzadeh Nanva

, et al: The role of lung ultrasonography scoring in predicting the need for surfactant therapy in neonates, with respiratory distress syndrome. J Diagn Med Sonogr 2023;19:348–354. doi:10.1177/87564793231167856.

41.

Haghi

Kahkouee

Kiani

, et al: The diagnostic accuracy of endobronchial ultrasound and spiral chest computed tomography scan in the prediction of infiltrating and non-infiltrating lymph nodes in patients undergoing endobronchial ultrasound. Pol J Radiol 2019;84:e565–e569.

42.

Akhoundi

Langroudi

Rajebi

, et al: Computed tomography pulmonary angiography for acute pulmonary embolism: prediction of adverse outcomes and 90-day mortality in a single test. Pol J Radiol 2019;84:e436–e446.

43.

Akhoundi

Faghihi Langroudi

Rezazadeh

, et al: Role of clinical and echocardiographic findings in patients with acute pulmonary embolism: prediction of adverse outcomes and mortality in 180 days. Tanaffos 2021;20(2):99–108.

44.

Akhoundi

Faghihi Langroud

Shafizadeh

Jabbarzadeh

Talebi

: Incidental abdominal aortic aneurysm in the psoriasis patient: a case report and review of literature. Galen Med J 2018;7:e1168.

45.

Akhoundi

Sedghian

Siami

, et al: Does adding the pulmonary infarction and right ventricle to left ventricle diameter ratio to the Qanadli index (a combined Qanadli index) more accurately, predict short-term mortality in patients with pulmonary embolism? [published online ahead of print June 16, 2023]. Indian J Radiol Imaging. doi:10.1055/s-0043-1769590.

46.

Lovrenski

: Lung ultrasonography of pulmonary complications in preterm infants with respiratory distress syndrome. Ups J Med Sci 2012;117(1):10–17.

47.

Ahuja

Saxena

Sodhi

Kumar

Khandelwal

: Role of transabdominal ultrasound of lung bases and follow-up in premature neonates with respiratory distress soon after birth. Indian J Radiol Imaging 2012;22(4):279–283.

48.

Louis

Belen

Farooqui

, et al: Prone versus supine position for lung ultrasound in neonates with respiratory distress. Am J Perinatol 2021;38(2):176–181.

49.

Oktem

Yigit

Oğuz

Celik

Haliloğlu

Yurdakok

: Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns. J Mater Fetal Neonatal Med 2019;34:281–286.

50.

Liu

Cao

Wang

Kong

: The role of lung ultrasound in diagnosis of respiratory distress syndrome in newborn infants. Iran J Pediatr 2015;25(1):e323.

The Accuracy of Various Lung Ultrasonography Findings in Predicting the Necessity for Surfactant Treatment in Neonates With Respiratory Distress Syndrome

Abstract

Objective:

Materials and Methods:

Results:

Conclusion:

Keywords

Materials and Methods

Patients

Lung Ultrasonography Protocol

Chest Radiography Protocol

Statistical Analysis

Results

Discussion

Limitations

Conclusion

Footnotes

Ethics Approval

Informed Consent

Animal Welfare

Trial Registration

Declaration of Conflicting Interests

Funding

ORCID iD

References