[go: up one dir, main page]
More Web Proxy on the site http://driver.im/ Skip to main content
Springer Nature Link
Log in

Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants

  • RESEARCH
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Lung ultrasound (LU) has emerged as the imaging technique of choice for the assessment of neonates with respiratory distress syndrome (RDS) at the bedside. Scoring systems were developed to quantify RDS severity and to predict the need for surfactant administration. There is no data on the comparison of the three main LU scores (LUS) proposed by Brat, Raimondi and Rodriguez-Fanjul. Moreover, there is not enough evidence to recommend which score and which cut-off has the best ability to predict surfactant need. The three LUS were compared in terms of ability to predict the need for surfactant and reproducibility in a cohort of very preterm infants. This was an observational, retrospective, multicenter study. Neonates below 32 weeks of gestational age with RDS, on non-invasive ventilation with a LU performed prior to surfactant administration (1–3 h of life) were included. Brat, Raimondi, and Rodriguez-Fanjul’s scores were calculated for each patient. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability to predict surfactant administration. K-Cohen test, Bland–Altman, and intraclass correlation coefficients were used to assess the intra and interobserver variability. Fifty-four preterm infants were enrolled. Brat, Raimondi, and Rodriguez-Fanjul scores showed a strong ability to predict the need for surfactant: the AUCs were 0.85 (95% CI 0.74–0.96), 0.85 (95% CI 0.75–0.96), and 0.79 (95% CI 0.67–0.92), respectively. No significant differences have been found between the AUCs using the DeLong test. Brat and Raimondi’s scores had an optimal cut-off value > 8, while the Rodriguez-Fanjul’s score > 10. The k-Cohen values of intraobserver agreement for Brat, Raimondi, and Rodriguez-Fanjul’s scores were 0.896 (0.698–1.000), 1.000 (1.000–1.000), and 0.922 (0.767–1.000), respectively. The k-Cohen values of interobserver agreement were 0.896 (0.698–1.000), 0.911 (0.741–1.000), and 0.833 (0.612–1.000), respectively.

Conclusions: The three LUS had an excellent ability to predict the need for surfactant and an optimal intra and interobserver agreement. The differences found between the three scores are minimal with negligible clinical implications. Since the optimal cut-off value differed, the same score should be used consistently within the same center.

What is Known:

• Lung ultrasound is a useful bedside imaging tool that should be used in the assessment of neonates with RDS

• Scoring systems or lung ultrasound scores allow to quantify the severity of the pulmonary disease and to predict the need for surfactant replacement therapy

What is New:

• The three lung ultrasound scores by Brat, Raimondi and Rodriguez-Fanjul have an excellent ability to predict the need for surfactant replacement therapy, although with different cut-off values

• All three lung ultrasound scores had an excellent intra and interobserver reproducibility

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
£29.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Singh Y, Tissot C, Fraga MV et al (2020) International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 24:65. https://doi.org/10.1186/s13054-020-2787-9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Corsini I, Parri N, Ficial B et al (2022) Lung ultrasound in Italian Neonatal Intensive Care Units: a national survey. Pediatr Pulmonol 1–8. https://doi.org/10.1002/ppul.26025

  3. Lichtenstein DA, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the Critically III. Chest 108:1345–1348. https://doi.org/10.1378/chest.108.5.1345

    Article  CAS  PubMed  Google Scholar 

  4. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL et al. (2008) Harrison’s principles of internal medicine, 17th ed. NY

  5. Conlon TW, Nishisaki A, Singh Y et al (2019) Moving beyond the stethoscope: diagnostic point-of-care ultrasound in pediatric practice. Pediatrics 144:e20191402. https://doi.org/10.1542/peds.2019-1402

  6. Corsini I, Parri N, Ficial B, Dani C (2020) Lung ultrasound in the neonatal intensive care unit: review of the literature and future perspectives. Pediatr Pulmonol 55:1550–1562. https://doi.org/10.1002/ppul.24792

    Article  PubMed  Google Scholar 

  7. Corsini I, Parri N, Gozzini E et al (2019) Lung ultrasound for the differential diagnosis of respiratory distress in neonates. Neonatology 77–84. https://doi.org/10.1159/000493001

  8. Nguyen J (2017) Call for point-of-care ultrasound training regimens in neonatal-perinatal medicine. J Pediatr 185:254. https://doi.org/10.1016/j.jpeds.2017.02.029

    Article  PubMed  Google Scholar 

  9. Montasser M, Kirolos S, Milan A, Meau-Petit V (2022) Neonatal point-of-care lung ultrasound: a UK-wide survey and the way forward. Arch Dis Child Fetal Neonatal Ed fetalneonatal-2022–324324. https://doi.org/10.1136/archdischild-2022-324324

  10. Perri A, Riccardi R, Iannotta R et al (2018) Lung ultrasonography score versus chest X-ray score to predict surfactant administration in newborns with respiratory distress syndrome. Pediatr Pulmonol 53:1231–1236. https://doi.org/10.1002/ppul.24076

    Article  PubMed  Google Scholar 

  11. Raimondi F, Yousef N, Migliaro F et al (2021) Point-of-care lung ultrasound in neonatology: classification into descriptive and functional applications. Pediatr Res 90:524–531. https://doi.org/10.1038/s41390-018-0114-9

    Article  PubMed  Google Scholar 

  12. Raimondi F, Migliaro F, Sodano A et al (2012) Can neonatal lung ultrasound monitor fluid clearance and predict the need of respiratory support? Crit Care 16:R220. https://doi.org/10.1186/cc11865

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mongodi S, De Luca D, Colombo A et al (2021) Quantitative lung ultrasound: technical aspects and clinical applications. Anesthesiology 134:949–965. https://doi.org/10.1097/ALN.0000000000003757

    Article  PubMed  Google Scholar 

  14. Corsini I, Ficial B, Ciarcià M et al (2022) Lung ultrasound scores in neonatal clinical practice: a narrative review of the literature. Pediatr Pulmonol 57:1157–1166. https://doi.org/10.1002/ppul.25875

    Article  PubMed  Google Scholar 

  15. Brat R, Yousef N, Klifa R et al (2015) Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr 169:e151797. https://doi.org/10.1001/jamapediatrics.2015.1797

  16. Raimondi F, Migliaro F, Corsini I, et al (2021) Lung ultrasound score progress in neonatal respiratory distress syndrome. Pediatrics 147:e2020030528. https://doi.org/10.1542/peds.2020-030528

  17. Rodriguez-Fanjul J, Jordan I, Balaguer M et al (2020) Early surfactant replacement guided by lung ultrasound in preterm newborns with RDS: the ULTRASURF randomised controlled trial. Eur J Pediatr 179:1913–1920. https://doi.org/10.1007/s00431-020-03744-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Raimondi F, Migliaro F, Corsini I et al (2021) Neonatal lung ultrasound and surfactant administration. Chest 160:2178–2186. https://doi.org/10.1016/j.chest.2021.06.076

    Article  CAS  PubMed  Google Scholar 

  19. Sweet DG, Carnielli V, Greisen G et al (2019) European consensus guidelines on the management of respiratory distress syndrome - 2019 update. Neonatology 115:432–450. https://doi.org/10.1159/000499361

    Article  PubMed  Google Scholar 

  20. Gomond-Le Goff C, Vivalda L, Foligno S et al (2020) Effect of different probes and expertise on the interpretation reliability of point-of-care lung ultrasound. Chest 157:924–931. https://doi.org/10.1016/j.chest.2019.11.013

    Article  PubMed  Google Scholar 

  21. López-Ratón M, Rodríguez-Álvarez MX, Suárez CC, Sampedro FG (2014) Optimal cutpoints: an R package for selecting optimal cutpoints in diagnostic tests. J Stat Softw 61:. https://doi.org/10.18637/jss.v061.i08

  22. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  23. Ficial B, Corsini I, Clemente M (2022) Feasibility, reproducibility and reference ranges of left atrial strain in preterm and term neonates in the first 48 h of life. Diagnostics 12:350 https://doi.org/10.3390/DIAGNOSTICS12020350

  24. De Luca D, van Kaam AH, Tingay DG et al (2017) The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity. Lancet Respir Med 5:657–666. https://doi.org/10.1016/S2213-2600(17)30214-X

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Bahadue FL, Soll R (2012) Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome. Cochrane Database Syst Rev 104:124–126. https://doi.org/10.1002/14651858.CD001456.pub2

    Article  Google Scholar 

  27. Raschetti R, Yousef N, Vigo G et al (2019) Echography-guided surfactant therapy to improve timeliness of surfactant replacement: a quality improvement project. J Pediatr 212:137-143.e1. https://doi.org/10.1016/j.jpeds.2019.04.020

    Article  PubMed  Google Scholar 

  28. Sweet DG, Carnielli V, Greisen G et al (2017) European consensus guidelines on the management of respiratory distress syndrome - 2016 update. Neonatology 111:107–125. https://doi.org/10.1159/000448985

    Article  CAS  PubMed  Google Scholar 

  29. Mongodi S, Santangelo E, De Luca D et al (2020) Quantitative lung ultrasound: time for a consensus? Chest 158:469–470. https://doi.org/10.1016/j.chest.2020.03.080

    Article  PubMed  Google Scholar 

  30. Brumley GW, Chernick V, Hodson WA et al (1967) Correlations of mechanical stability, morphology, pulmonary surfactant, and phospholipid content in the developing lamb lung. J Clin Investig 46:863–873. https://doi.org/10.1172/JCI105586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Copetti R, Cattarossi L, Macagno F et al (2008) Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology 94:52–59. https://doi.org/10.1159/000113059

    Article  PubMed  Google Scholar 

  32. Loi B, Vigo G, Baraldi E et al (2021) Lung ultrasound to monitor extremely preterm infants and predict bronchopulmonary dysplasia a multicenter longitudinal cohort study. Am J Respir Crit Care Med 203:1398–1409. https://doi.org/10.1164/rccm.202008-3131OC

    Article  CAS  PubMed  Google Scholar 

  33. Loi B, Regiroli G, Foligno S et al (2023) Respiratory and haemodynamic effects of 6h-pronation in neonates recovering from respiratory distress syndrome, or affected by acute respiratory distress syndrome or evolving bronchopulmonary dysplasia: a prospective, physiological, crossover, controlled cohort study. EClinicalMedicine 55:101791. https://doi.org/10.1016/j.eclinm.2022.101791

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

  35. Szymański P, Kruczek P, Hożejowski R, Wais P (2021) Modified lung ultrasound score predicts ventilation requirements in neonatal respiratory distress syndrome. BMC Pediatr 21:17. https://doi.org/10.1186/s12887-020-02485-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  37. Levy PT, Holland MR, Sekarski TJ et al (2013) Feasibility and reproducibility of systolic right ventricular strain measurement by speckle-tracking echocardiography in premature infants. J Am Soc Echocardiogr 26:1201–1213. https://doi.org/10.1016/j.echo.2013.06.005

    Article  PubMed  PubMed Central  Google Scholar 

  38. Capasso L, Pacella D, Migliaro F et al (2023) Can lung ultrasound score accurately predict surfactant replacement? A systematic review and meta-analysis of diagnostic test studies. Pediatr Pulmonol 58:1427–1437. https://doi.org/10.1002/ppul.26337

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy

    Iuri Corsini, Martina Ciarcià, Monica Fusco & Carlo Dani

  2. Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Maria Beatrice Lenzi, Enrico Petoello, Alice Iride Flore, Silvia Nogara & Benjamim Ficial

  3. Neonatal Intensive Care Unit, Hospital Cervello Palermo, Palermo, Italy

    Federico Matina & Antonella Gangemi

  4. Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy

    Letizia Capasso & Francesco Raimondi

  5. Neonatology Department, Institut d’Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain

    Javier Rodriguez-Fanjul

  6. Department of Neurosciences, Drug Research and Child Health, University of Florence, PsychologyFlorence, Italy

    Carlo Dani

Authors
  1. Iuri Corsini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Beatrice Lenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martina Ciarcià
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Federico Matina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Enrico Petoello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alice Iride Flore
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Silvia Nogara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Antonella Gangemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Monica Fusco
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Letizia Capasso
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Francesco Raimondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Javier Rodriguez-Fanjul
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Carlo Dani
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Benjamim Ficial
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: B.F., I.C., F.M., C.D.; data curation: B.F., I.C., M.B.L., M.C., E.P., A.I.F., S.N., M.F.; methodology: B.F., I.C., M.C., L.C., J.R.F., A.G; supervision: I.C., B.F., M.C., F.R., C.D.; writing—original draft: B.F., I.C.; writing—review and editing: I.C., M.B.L., M.C., F.M., E.P., A.I.F., S.N., A.G., M.F., L.C., F.R., J.R.F., C.D., and B.F. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Iuri Corsini.

Ethics declarations

Competing interests

IC received lecture fees from Chiesi farmaceutici. CD received honoraria from Chiesi Farmaceutici Spa and Vyaire Medical Inc. for scientific consultancy. All the other Authors has nothing to declare

Ethics approval

The study was approved by the Tuscany Paediatric Regional Ethics Committee approved the study (n 131/2023). The parents or guardians of babies enrolled gave their written informed consent. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Competing interest

IC received lecture fees from Chiesi farmaceutici. CD received honoraria from Chiesi Farmaceutici Spa and Vyaire Medical Inc. for scientific consultancy. All the other authors has nothing to declare.

Additional information

Communicated by Daniele De Luca

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 137 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Corsini, I., Lenzi, M.B., Ciarcià, M. et al. Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants. Eur J Pediatr 182, 5375–5383 (2023). https://doi.org/10.1007/s00431-023-05200-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-023-05200-z

Keywords

Search

Navigation