Lung ultrasonography score as a predictor of RDS severity in premature infants

Meddy Romadhan; Risa Etika; Martono Tri Utomo; Dina Angelika; Kartika Darma Handayani; Wurry Ayuningtyas; Lenny Violetta

doi:10.23750/abm.v96i2.16456

Lung ultrasonography score as a predictor of RDS severity in premature infants

Authors

Meddy Romadhan Department of Child Health, School of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Risa Etika Department of Child Health, School of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Martono Tri Utomo Department of Child Health, School of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Dina Angelika Department of Child Health, School of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Kartika Darma Handayani Department of Child Health, School of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Wurry Ayuningtyas Department of Child Health, School of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Lenny Violetta Department of Radiology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia

Keywords:

Lung Ultrasound, Predictor, Premature Infants, Respiratory Distress Syndrome, Severity, Ultrasonography

Abstract

Background and aim: This study aimed to analyze lung ultrasound (USG) scores as a predictor of Respiratory Distress Syndrome (RDS) severity in premature infants. The research was conducted using an observational analytic method with a cross-sectional approach on 51 premature infants treated in the NICU at Dr. Soetomo Hospital, Surabaya.

Methods: Data collection was performed by measuring lung USG scores at 0-3 hours and 12-24 hours after birth and analyzing the relationship between these scores and the severity of RDS based on chest X-rays, Downes Score, and Oxygen Saturation Index (OSI).

Results: The study showed a significant positive correlation between lung USG scores at 12-24 hours and RDS severity based on chest X-rays (r=0.307, p=0.029). Additionally, there was a significant relationship between lung USG scores at 12-24 hours and Downes Score (r=0.355, p=0.011), while lung USG scores at 0-3 hours had a positive correlation with OSI (r=0.483, p=0.049).

Conclusions: This study demonstrated that lung USG scores can be used as a predictor of RDS severity in premature infants, supporting the potential of lung USG as a non-invasive and effective method for early RDS assessment, which may assist in guiding clinical decisions related to surfactant administration and other interventions.

References

1. Wulandari RD, Laksono AD, Matahari R. Policy to decrease low birth weight in Indonesia: who should be the target? Nutrients. 2023;15(2):465. doi: 10.3390/nu15020465

2. Ledinger D, Nußbaumer-Streit B, Gartlehner G. WHO-Leitlinie: Versorgung von Frühgeborenen und Neugeborenen mit niedrigem Geburtsgewicht. Dtsch Gesundheitswes. 2024;86(4):289-93. doi: 10.1055/a-2251-5686.

3. Kemenkes RI. Profil Kesehatan Indonesia 2021. Jakarta: Pusdatin Kemenkes; 2022. Available from: https://repository.kemkes.go.id/book/828.

4. G B, F G, S N, et al. Indonesia Demographic and Health Survey 2017: adolescent reproductive health. Key indicators report. Iran J Pediatr. 2018;27(5). doi: 10.5812/ijp.11523

5. Pholanun N, Srisatidnarakul B, Longo J. The incidence and factors predicting survival among preterm infants with respiratory distress syndrome admitted to neonatal intensive care unit. J Ners. 2022;17(2):138-43. doi: 10.20473/jn.v17i2.36860.

6. Dyer J. Neonatal respiratory distress syndrome: tackling a worldwide problem. P T. 2019;44(1):12-4. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6336202/

7. Thébaud B, Goss KN, Laughon M, et al. Bronchopulmonary dysplasia. Nat Rev Dis Primers. 2019;5(1):78. doi: 10.1038/s41572-019-0127-7

8. Yadav S, Lee B, Kamity R. Neonatal respiratory distress syndrome. [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560779/

9. Widiastari EF, Graha WA, Pardede M. Lung bullae due to septic pulmonary embolism in a 4-year-old child: a case report. Comorbid Orthop Illn Details. 2022;1(3):15-20. doi: 10.55047/comorbid.v1i3.355.

10. Sweet DG, Carnielli VP, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology. 2023;120(1):3-23. doi: 10.1159/000528914.

11. Chen IL, Chen HL. New developments in neonatal respiratory management. Pediatr Neonatol. 2022;63(4):341-7. doi: 10.1016/j.pedneo.2022.02.002.

12. Ferdian H, Wahid DI, Samad S, Wardani AE, Alam GS, Moelyo AG. Lung ultrasound in diagnosing neonatal respiratory distress syndrome: a meta-analysis. Paediatr Indones. 2019;59(6):340-8. doi: 10.14238/pi59.6.2019.340-8.

13. Norman M, Jonsson B, Wallström L, Sindelar R. Respiratory support of infants born at 22-24 weeks of gestational age. Semin Fetal Neonatal Med. 2022;27(2):101328. doi: 10.1016/j.siny.2022.101328.

14. Zong H, Huang Z, Zhao J, et al. The value of lung ultrasound score in neonatology. Front Pediatr. 2022;10:791664. doi: 10.3389/fped.2022.791664

15. Sett A, Rogerson SR, Foo GWC, et al. Estimating preterm lung volume: a comparison of lung ultrasound, chest radiography, and oxygenation. J Pediatr. 2023;259:113437. doi: 10.1016/j.jpeds.2023.113437

16. Raimondi F, Migliaro F, Corsini I, et al. Neonatal lung ultrasound and surfactant administration. Chest. 2021;160(6):2178-86. doi: 10.1016/j.chest.2021.06.076.

17. Perri A, Fattore S, D’Andrea V, et al. Lowering of the neonatal lung ultrasonography score after nCPAP positioning in neonates over 32 weeks of gestational age with neonatal respiratory distress. Diagnostics (Basel). 2022;12(8):1909. doi: 10.3390/diagnostics12081909.

18. Stewart DL, Elsayed Y, Fraga MV, et al. Use of point-of-care ultrasonography in the NICU for diagnostic and procedural purposes. Pediatrics. 2022;150(6):e2022060053. doi: 10.1542/peds.2022-060053.

19. Vardar G, Karadag N, Karatekin G. The role of lung ultrasound as an early diagnostic tool for need of surfactant therapy in preterm infants with respiratory distress syndrome. Am J Perinatol. 2020;38(14):1547-56. doi: 10.1055/s-0040-1714207.

20. Basso O, Wilcox A. Mortality risk among preterm babies. Epidemiology. 2010;21(4):521-7. doi: 10.1097/ede.0b013e3181debe5e.

21. Liu J, Yang N, Liu Y. High-risk factors of respiratory distress syndrome in term neonates: a retrospective case-control study. Balkan Med J. 2014;33(1):64-8. doi: 10.5152/balkanmedj.2014.8733.

22. Permana I, Judistiani RTD, Bakhtiar B, Alia A, Yuniati T, Setiabudiawan B. Incidence of respiratory distress syndrome and its associated factors among preterm neonates: study from West Java tertiary hospital. Int J Trop Vet Biomed Res. 2022;7(1). doi: 10.21157/ijtvbr.v7i1.27043.

23. Urs PS, Khan F, Maiya PP. Bubble CPAP - a primary respiratory support for respiratory distress syndrome in newborns. Med J Armed Forces India. 2009;65(5):409-11. https://pubmed.ncbi.nlm.nih.gov/19179737.

24. Gorman EA, O'Kane CM, McAuley DF. Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management. Lancet. 2022;400(10358):1157-70. doi: 10.1016/s0140-6736(22)01439-8.

25. Liszewski MC, Stanescu AL, Phillips GS, Lee EY. Respiratory distress in neonates. Radiol Clin North Am. 2017;55(4):629-44. doi: 10.1016/j.rcl.2017.02.006.

26. Marzani AB, Hartono ARS, Monalisa C, et al. Hyaline membrane disease in preterm newborn. Med Clin Updat. 2022;1(1):44-5. doi: 10.58376/mcu.v1i1.14.

27. Zerbarani WO. Perbandingan antara Foto Thorax dan Ultrasonografi Thorax dengan Gambaran Klinis pada Pasien Hyaline Membrane Disease [thesis]. Makassar: Universitas Hasanuddin; 2022. Available from: https://repository.unhas.ac.id/id/eprint/22848/2/C125172005_tesis_20-06-2022%201-2.pdf.

28. Hiles M, Culpan AM, Watts C, Munyombwe T, Wolstenhulme S. Neonatal respiratory distress syndrome: chest X-ray or lung ultrasound? A systematic review. Ultrasound. 2017;25(2):80-91. doi: 10.1177/1742271x16689374.

29. Dr Mz, Dr Nsm, Dr Ah, et al. Evaluation of oxygenation index compared with oxygen saturation index among neonates admitted to the NICU. Acta Med Iran. 2021;59(6). doi: 10.18502/acta.v59i6.6896.

30. Buonocore G, Bracci R, Weindling M. Neonatology. Cham: Springer; 2018. doi: 10.1007/978-3-319-29489-6.

31. Elsayed Y, Wahab MGA, Mohamed A, et al. Point-of-care ultrasound (POCUS) protocol for systematic assessment of the crashing neonate—expert consensus statement of the international crashing neonate working group. Eur J Pediatr. 2022;182(1):53-66. doi: 10.1007/s00431-022-04636-z.

32. Dumpa V, Avulakunta I, Bhandari V. Respiratory management in the premature neonate. Expert Rev Respir Med. 2023;17(2):155-70. doi: 10.1080/17476348.2023.2183843.

33. Raimondi F, Yousef N, Migliaro F, et al. Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res. 2018;90(3):524-31. doi: 10.1038/s41390-018-0114-9.

34. El-Malah HEDGM, Hany S, Mahmoud MK, Ali AM. Lung ultrasonography in evaluation of neonatal respiratory distress syndrome. Egypt J Radiol Nucl Med. 2015;46(2):469-74. doi: 10.1016/j.ejrnm.2015.01.005.

35. De Martino L, Yousef N, Ben-Ammar R, et al. Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics. 2018;142(3):e20180463. doi: 10.1542/peds.2018-0463.

36. Liu J. Ultrasound diagnosis and grading criteria of neonatal respiratory distress syndrome. J Matern Fetal Neonatal Med. 2023;36(1). doi: 10.1080/14767058.2023.2206943.

37. De Luca D, Ojembarrena AA, Raimondi F. Scientific evidence is the only common ground for the debate on neonatal lung ultrasound. Neonatology. 2023;120(3):402-3. doi: 10.1159/000530023.

38. Fernández S. Basic notions of lung ultrasound in neonatology. Arch Argent Pediatr. 2022;120(6):e246. doi: 10.5546/aap.2022.eng.e246.

39. Ashwini K, Badiger S, S ST. Utility of oxygen saturation index (OSI) over oxygenation index (OI) in monitoring of neonates with respiratory diseases. Res Sq [Preprint]. 2024. doi: 10.21203/rs.3.rs-3880807/v1.

40. Muniraman HK, Song AY, Ramanathan R, et al. Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure. JAMA Netw Open. 2019;2(3):e191179. doi: 10.1001/jamanetworkopen.2019.1179.

41. Tana M, Tirone C, Aurilia C, et al. Respiratory management of the preterm infant: supporting evidence-based practice at the bedside. Children (Basel). 2023;10(3):535. doi: 10.3390/children10030535.

42. Khalesi N, Choobdar FA, Khorasani M, Sarvi F, Aski BH, Khodadost M. Accuracy of oxygen saturation index in determining the severity of respiratory failure among preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med. 2019;34(14):2334-9. doi: 10.1080/14767058.2019.1666363