Lung ultrasound may predict surfactant need in respiratory distress syndrome

Lung ultrasound (LUS) is an accurate and reliable diagnostic method than chest X‐ray for predicting the need for surfactant therapy in newborns with respiratory distress syndrome (RDS), finds a new study published in the journal Pediatric Pulmonology. Identifying the need for surfactant therapy in such newborns will facilitate a reduction of radiation exposure and early treatment.

Riccardo Riccardi, Department of Neonatology, Catholic University of the Sacred HeartRome, Italy, and colleagues conducted the study to verify the diagnostic accuracy of LUS score to predict the early need for surfactant therapy in newborns with RDS and to compare it with a chest X‐ray score.

RDS is a breathing disorder in neonates caused by underdeveloped lung anatomy and surfactant deficiency. For its treatment, oxygen is given with a small amount of continuous positive airway pressure (CPAP), and intravenous fluids are administered for the stabilization of blood sugar, blood salts, and blood pressure. If the condition of the baby worsens, a breathing tube is inserted into the trachea and intermittent breaths are given by a mechanical device. An exogenous preparation of surfactant, either synthetic or extracted from animal lungs, is given through the breathing tube into the lungs.

For this prospective diagnostic accuracy study, the researchers included all newborns admitted for respiratory distress and initially treated with nasal CPAP. LUS was performed within 2 h from nasal CPAP positioning and in any case before surfactant administration. A chest X‐ray was also performed. An LUS score and an X‐ray score were used and compared. The ability of the scores to predict surfactant administration was evaluated through ROC analysis.

Key Findings:

• In the population of 56 newborns with mean gestational age of 31 weeks (SD 3) and mean birth weight of 1442 g (SD 520), LUS score showed higher AUC than X‐ray score in early recognition of infants with respiratory distress syndrome requiring surfactant treatment (0.94; 95%CI, 0.89‐0.98; P < 0.001 vs 0.80; 95%CI, 0.74‐0.86).


• It also showed also higher sensitivity (86% vs 82%), higher specificity (88% vs 76%), better positive (83% vs 69%), and negative (91% vs 87%) predictive values.

"LUS is a non‐invasive, bedside and reproducible method that could improve the management of neonatal respiratory distress. It is accurate and reliable to early identify patients who will need treatment with surfactant allowing both an early treatment and a reduction of radiation exposure," concluded the authors.