Lung ultrasonography in the management of preterm (≤34 weeks) neonates with respiratory distress syndrome.

Background: The diagnosis of respiratory distress syndrome (RDS) is largely clinical with the support of a chest X-ray. Lung ultrasound (LUS) is emerging as a reliable bedside technique to evaluate RDS.

Objective: To determine the LUS for preterm neonates ≤34 weeks of gestation admitted within 12 h of birth with clinical suspicion of RDS and to compare the lung USG score with the chest X-ray score to predict the need for surfactant administration.

Methods: This prospective observational study was conducted among 67 preterm neonates with clinical suspicion of RDS admitted to our NICU. Neonates underwent a clinical examination, followed promptly by a chest X-ray and LUS. The decision to administer surfactant was made on the basis of the clinical picture and chest X-ray. The NICU team was blinded to the findings of LUS, and the radiologist was blinded to the X-ray chest report.

Results: More than two-thirds (67.2%) of the enrolled neonates with clinical suspicion of RDS required surfactant administration. The median LUS score was 12 among those who needed surfactant, while it was 8 for those who did not need surfactant. A receiver operator curve was constructed for the LUS and chest X-ray scores to determine the need for surfactant administration. The area under the curve (AUC) for the LUS score was higher than that of the chest X-ray score (0.962 vs. 0.811; p < 0.001) for predicting the need for surfactant administration. The sensitivity and specificity for the LUS and chest X-ray scores were 95.6% versus 93.3% and 91% versus 50%, respectively.

Conclusions: The LUS score is more useful than the chest X-ray score for determining the need for surfactant in preterm neonates with RDS suspicion.