The Promise of Lung Ultrasound to Monitor Evolution of Chronic Respiratory Morbidity in Preterm Infants

BACKGROUND: Lung ultrasound (LUS) is a bedside technique that can be used on diagnosis and follow-up of neonatal respiratory diseases. However, there are rare reports on the ultrasound features of bronchopulmonary dysplasia (BPD) which is one of the most common chronic lung diseases in preterm infants. OBJECTIVE: To describe the ultrasound features of different BPD levels, and to investigate the value of ultrasound in evaluating moderate-to-severe BPD. METHODS: In this prospective cohort study, newborns of less than 37 weeks’ gestational age in neonatal intensive care unit (NICU) were included. The LUS characteristics including pleural line, alveolar-interstitial syndrome (AIS), retrodiaphragmatic hyperechogenicity and diaphragmatic morphology were observed and recorded. The reliability of LUS in evaluating moderate and severe BPD were compared and calculated. RESULTS: A total of 108 infants were enrolled in our study: 39, 24, 29, 16 infants had non, mild, moderate and severe BPD. The median(IQR) pleura thickness in the moderate-to-severe BPD group was 1.7(1.6–1.85) mm, which was thicker than that in the none-to-mild BPD infants (P < 0.001), meanwhile the proportions of rough pleural lines, diffuse AIS, retrodiaphragmatic hyperechogenicity, small cysts above the diaphragm and rough diaphragm in the moderate-to-severe BPD group were also higher than those in none-to-mild BPD group (86.7% vs 36.5, 57.8% vs 7.9%, 37.8% vs 0, 33.3% vs 0, P < 0.001). In evaluating moderate-to-severe BPD, rough pleura had 91.1% (95% confidence interval [CI]: 0.793–0.965) in sensitivity, 91.3% (95% CI: 0.797–0.966) in negative predictive value (NPV), and 66.7% (95% CI: 0.544–0.771) in specificity. Small cysts had 100% (95% CI: 0.941-1) in specificity, 100% (95% CI: 0.816-1) in PPV, and 37.8% in sensitivity (95% CI: 0.251–0.524). Rough diaphragm had 100% (95% CI: 0.943-1) in sensitivity, 100% (95% CI: 0.796-1) in PPV and 33.3% (95% CI: 0.211–0.478) in specificity. CONCLUSIONS: Depending on its unique advantages such as convenient, no radiation and repeatable, LUS is a valuable imaging method in assessing the severity of BPD, especially in moderate and severe BPD.

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Prediction of extubation readiness using lung ultrasound in preterm infants

Pediatric Pulmonology ◽

10.1002/ppul.25383 ◽

2021 ◽

Author(s):

Reem M. Soliman ◽

Yasser Elsayed ◽

Reem N. Said ◽

Abdulaziz M. Abdulbaqi ◽

Rania H. Hashem ◽

...

Keyword(s):

Preterm Infants ◽

Lung Ultrasound

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Respiratory Morbidity in Late-Preterm Infants: Prevention Is Better Than Cure!

American Journal of Perinatology ◽

10.1055/s-2007-1022471 ◽

2008 ◽

Vol 25 (2) ◽

pp. 075-078 ◽

Cited By ~ 27

Author(s):

Lucky Jain

Keyword(s):

Preterm Infants ◽

Late Preterm ◽

Respiratory Morbidity ◽

Late Preterm Infants ◽

Better Than

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Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Neonatology ◽

10.1159/000517585 ◽

2021 ◽

pp. 1-9

Author(s):

Victoria Aldecoa-Bilbao ◽

Mar Velilla ◽

Marta Teresa-Palacio ◽

Carla Balcells Esponera ◽

Ana Herranz Barbero ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Lung Ultrasound ◽

Respiratory Support ◽

Very Preterm Infants ◽

Very Preterm ◽

Pleural Line ◽

Respiratory Management ◽

Postmenstrual Age ◽

Severity Of The Disease

Introduction: Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. Methods: Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. Results: Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79–0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70–0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84–0.97), p < 0.001. Conclusion: LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

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Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

Epidemiology and Infection ◽

10.1017/s0950268813001738 ◽

2013 ◽

Vol 142 (7) ◽

pp. 1362-1374 ◽

Cited By ~ 17

Author(s):

B. FAUROUX ◽

J.-B. GOUYON ◽

J.-C. ROZE ◽

C. GUILLERMET-FROMENTIN ◽

I. GLORIEUX ◽

...

Keyword(s):

Risk Factors ◽

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Respiratory Morbidity ◽

Study Cohort ◽

Recurrent Wheezing ◽

Term Infants ◽

Independent Risk Factors ◽

Syncytial Virus

SUMMARYThe aim of this study was to describe the incidence and risk factors for respiratory morbidity during the 12-month period following the first respiratory syncytial virus (RSV) season in 242 preterm infants [<33 weeks gestational age (GA)] without bronchopulmonary dysplasia and 201 full-term infants (39–41 weeks GA) from the French CASTOR study cohort. Preterm infants had increased respiratory morbidity during the follow-up period compared to full-terms; they were more likely to have wheezing (21% vs. 11%, P = 0·007) and recurrent wheezing episodes (4% vs. 1%, P = 0·049). The 17 infants (14 preterms, three full-terms) who had been hospitalized for RSV-confirmed bronchiolitis during their first RSV season had significantly more wheezing episodes during the follow-up period than subjects who had not been hospitalized for RSV-confirmed bronchiolitis (odds ratio 4·72, 95% confidence interval 1·71–13·08, P = 0·003). Male gender, birth weight <3330 g and hospitalization for RSV bronchiolitis during the infant's first RSV season were independent risk factors for the development of wheezing episodes during the subsequent 12-month follow-up period.

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Bedside Lung Ultrasound As A Predictor Of The Extubation Readiness In Preterm Infants

10.1542/peds.147.3_meetingabstract.686 ◽

2021 ◽

Author(s):

Veronica M. Samedi ◽

Kaarthigeyan Kalaniti ◽

Sibasis Daspal

Keyword(s):

Preterm Infants ◽

Lung Ultrasound

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Lung ultrasound in preterm infants with respiratory distress: experience in a neonatal intensive care unit

European Journal of Pediatrics ◽

10.1007/s00431-019-03470-0 ◽

2019 ◽

Vol 179 (1) ◽

pp. 81-89 ◽

Cited By ~ 7

Author(s):

Rebeca Gregorio-Hernández ◽

María Arriaga-Redondo ◽

Alba Pérez-Pérez ◽

Cristina Ramos-Navarro ◽

Manuel Sánchez-Luna

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Respiratory Distress ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Lung Ultrasound

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Respiratory Severity Score with Regard to Birthweight during the Early Days of Life for Predicting Pulmonary Hypertension in Preterm Infants

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa013 ◽

2020 ◽

Vol 66 (6) ◽

pp. 561-568 ◽

Cited By ~ 1

Author(s):

Yu Mi Seo ◽

Sook Kyung Yum ◽

In Kyung Sung

Keyword(s):

Pulmonary Hypertension ◽

Preterm Infants ◽

Severity Score ◽

Statistical Significance ◽

Multivariable Analysis ◽

Oxygenation Index ◽

Respiratory Support ◽

Respiratory Morbidity ◽

Operating Characteristics ◽

Potential Marker

Abstract Objective The respiratory severity score (RSS) has been demonstrated to be associated with the oxygenation index in intubated newborn infants. We aimed to evaluate the usefulness of RSS with regard to birthweight (BW) in preterm infants for predicting an association with future pulmonary hypertension (PH). Methods Preterm infants with <30 weeks’ gestation and <1250 g BW were reviewed and grouped into two (PH vs. no PH). Basic perinatal characteristics, comorbidities and parameters reflecting lung condition, including duration of invasive mechanical ventilator care, were compared. Respiratory support parameters (FiO2, RSS and RSS/kg) during the first 5 days of birth (0–120 h) were compared between the groups, and receiver operating characteristics curves were produced to evaluate the association with PH. Results RSS/kg, of the three respiratory support parameters, demonstrated significantly higher values in the PH group in the early days of life. Particularly, RSS/kg at day 2 of life had the greatest area under the curve [0.762, 95% confidence interval (CI) 0.655–0.869, p < 0.001] and maintained statistical significance [odds ratio (OR) 1.352, 95% CI 1.055–1.732, p = 0.017] in the multivariable analysis for a potential association with PH, along with gestational age (OR 0.996, 95% CI 0.993–0.999, p = 0.015) and preterm premature rupture of membrane >18 h (OR 4.907, 95% CI 1.436–16.765, p = 0.011). Conclusion RSS/kg is a potential marker associated with the development of PH. Future studies could verify its usefulness as a reliable surrogate for predicting respiratory morbidity in clinical settings.

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