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A Modified Lung Ultrasound Score for Assessing Oxygenation Status and Predicting the Need for Invasive Ventilation in Preterm Neonates with RDS
Piotr Kruczek
Ujastek Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7596-1533
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pediatrics.
Purpose
We propose a modified lung ultrasound score (LUS) in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The LUS was evaluated for validity, interrater agreement and prognostic power in relation to the need for respiratory support on day of life (DOL) 3. The hypothesis of the dominant weight of posterior scans in the LUS was also verified.
Materials and methods
A total of 647 serial lung scans were performed in 70 preterm infants <32 weeks gestation and birth weight <1500 g. Assessments were performed within 24 hours of birth (LUS0) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS was correlated to oxygen saturation over fraction of inspired oxygen (SpO2/FiO2) and mode of respiratory support. Probabilities of the need for respiratory support on DOL 3 were assessed with ordinal logistic regression.
Results
The LUS correlated significantly with SpO2/FiO2 (Spearman rho = -0.635; p<0.0001) and had excellent interrater agreement (Cronbach’s alpha = 0.99). Posterior fields had dominant weight over the anterior fields (ls mean [confidence level]) 4.0 [3.8–4.1] vs 2.2 [2.0–2.4]; p<0.0001. Significant predictors of ventilation requirements on DOL 3 were LUS0 (p<0.016) and birth weight (BW) (p<0.0001); invasive ventilation was the most likely option with LUS0 ≥7 (BW 900 g), ≥10 (BW 1050 g) and ≥15 (BW 1280 g).
Conclusion
Postbirth LUS predicts the need for mechanical ventilation on DOL 3. Posterior fields play a dominant role in sonographic assessment of lungs in neonatal RDS.
Keywords
lung ultrasound, respiratory distress syndrome, neonate
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CURRENT STATUS: Published
Editor assigned
On 13 Dec, 2020
Submission checks complete
On 13 Dec, 2020
Editor invited
On 13 Dec, 2020
Version 1
Posted 17 Sep, 2020
Published
On 06 Jan, 2021
Published
On 06 Jan, 2021
No community comments so far
Review #3 received
Received 26 Oct, 2020
Editorial decision: Major revision
On 26 Oct, 2020
Reviewer #3 agreed
On 05 Oct, 2020
Review #2 received
Received 29 Sep, 2020
Reviewer #2 agreed
On 21 Sep, 2020
Review #1 received
Received 19 Sep, 2020
Reviewers invited
Invitations sent on 18 Sep, 2020
Reviewer #1 agreed
On 18 Sep, 2020
First submitted
On 03 Sep, 2020
Editor assigned
On 03 Sep, 2020
Submission checks complete
On 02 Sep, 2020
Editor invited
On 02 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
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Subject Areas
Pediatrics
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This preprint is under consideration at BMC Pediatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
A Modified Lung Ultrasound Score for Assessing Oxygenation Status and Predicting the Need for Invasive Ventilation in Preterm Neonates with RDS
Piotr Kruczek
Ujastek Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7596-1533
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Editor assigned
On 13 Dec, 2020
Submission checks complete
On 13 Dec, 2020
Editor invited
On 13 Dec, 2020
Version 1
Posted 17 Sep, 2020
Published
On 06 Jan, 2021
Published
On 06 Jan, 2021
No community comments so far
Review #3 received
Received 26 Oct, 2020
Editorial decision: Major revision
On 26 Oct, 2020
Reviewer #3 agreed
On 05 Oct, 2020
Review #2 received
Received 29 Sep, 2020
Reviewer #2 agreed
On 21 Sep, 2020
Review #1 received
Received 19 Sep, 2020
Reviewers invited
Invitations sent on 18 Sep, 2020
Reviewer #1 agreed
On 18 Sep, 2020
First submitted
On 03 Sep, 2020
Editor assigned
On 03 Sep, 2020
Submission checks complete
On 02 Sep, 2020
Editor invited
On 02 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Pediatrics.
Purpose
We propose a modified lung ultrasound score (LUS) in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The LUS was evaluated for validity, interrater agreement and prognostic power in relation to the need for respiratory support on day of life (DOL) 3. The hypothesis of the dominant weight of posterior scans in the LUS was also verified.
Materials and methods
A total of 647 serial lung scans were performed in 70 preterm infants <32 weeks gestation and birth weight <1500 g. Assessments were performed within 24 hours of birth (LUS0) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS was correlated to oxygen saturation over fraction of inspired oxygen (SpO2/FiO2) and mode of respiratory support. Probabilities of the need for respiratory support on DOL 3 were assessed with ordinal logistic regression.
Results
The LUS correlated significantly with SpO2/FiO2 (Spearman rho = -0.635; p<0.0001) and had excellent interrater agreement (Cronbach’s alpha = 0.99). Posterior fields had dominant weight over the anterior fields (ls mean [confidence level]) 4.0 [3.8–4.1] vs 2.2 [2.0–2.4]; p<0.0001. Significant predictors of ventilation requirements on DOL 3 were LUS0 (p<0.016) and birth weight (BW) (p<0.0001); invasive ventilation was the most likely option with LUS0 ≥7 (BW 900 g), ≥10 (BW 1050 g) and ≥15 (BW 1280 g).
Conclusion
Postbirth LUS predicts the need for mechanical ventilation on DOL 3. Posterior fields play a dominant role in sonographic assessment of lungs in neonatal RDS.
Figure 1
Figure 2
Figure 3
Figure 4