360 - Utilizing lung ultrasound to analyze respiratory distress syndrome in premature babies- a multicenter prospective study

Publication Number: 360.7088

Manisha Singh, Baylor Scott and White, Temple, TX, United States; Sara Mohamed, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Julianna Diddle, Phoenix Children's Hospital, Chandler, AZ, United States; Lauren Ridgway, Phoenix Children's, Phoenix, AZ, United States; Delaney Wresch, Phoenix Children's Hospital, Phoenix, AZ, United States; Raza Bajwa, Baylor scott and white, Round Rock, TX, United States; Vinayak Govande, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Muppala Raju, Baylor Scott White McLane Children's Medical Center, Temple, TX, United States; Marc Ellsworth, Phoenix Children's Hospital, Phoeinx, AZ, United States; Jennifer Shepherd, CHLA/USC, Los Angeles, CA, United States; Kathie Laitano, Phoenix Childrens Hospital, Phoenix, AZ, United States; Hemananda Muniraman, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States

Background: Point-of-care ultrasound of lungs (LUS) is a non-invasive, non-ionizing modality increasingly being used in intensive care units and emergency departments to aid clinical decision making. Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and mortality in preterm infants. RDS decreases in frequency as gestational age and birth weight increases. LUS allows real-time detection of RDS through dynamic imaging, allowing for the capture of images of the pleura, abnormalities to lung parenchyma, and airway structures. This can enhance clinical management and allow quick decision-making and the ability to visualize disease progression.

Objective: Our goal was to evaluate the association of LUS between gestational age groups with RDS.

Design/Methods: Prospective multicenter study (Clinical Trials ID: NCT05925075) that included preterm infants born less than 32 weeks gestational age (GA). Standardized LUS was performed on days of life (DOL) 7, 14, 21, 28 and 36-weeks postmenstrual age (PMA). The procedure involved obtaining six images (4 anterior chest wall views and 2 lateral views on the right and left sides). Baseline characteristics and respiratory support were collected at time of imaging. LUS scores were compared between extremely preterm infants born less than 28 weeks and moderately preterm infants of 29-32 weeks gestation at the above time points.

Results: A total of 266 LUS were performed on 52 infants. There were 28 infants in the extremely premature group (mean GA 25.4 weeks and birth weight (BW) of 846 g) and 24 infants in the moderately preterm group (mean GA 29.9 weeks and BW 1375 g). Rates of cesarean section, surfactant administration, oxygen requirements and need for invasive mechanical ventilation were higher in the extremely preterm group (Table 1). The median LUS scores were higher at DOL 7 (11 vs 4) , 14 ( 12 vs 4) , 21 (12 vs 4) and 28 (12 vs 3) in extremely preterm infants ( p< 0.01) (Table 1). At 36 weeks PMA, median LUS scores remained higher at 8 compared to 2 in extremely preterm infants (Figure 1).

Conclusion(s): Extreme preterm infants were associated with requiring higher respiratory support and higher LUS scores suggesting an association between severity of RDS and LUS. LUS may be a useful modality as a marker for RDS as well as risk of BPD and may have a utility in clinical management. Enrollment is ongoing to strengthen the findings further.

Table 1: Lung US results in preterm infants with RDS
Table 1-LUS.pdfTable 1 shows characteristics of patient population in study and average LUS scores at specified time points between extremely premature and moderately premature grouped infants.

Figure 1: LUS results between two comparison groups
Figure 1 LUS.pdfFigure 1 shows the average LUS scores of extremely premature infants which are higher than the scores of the moderately premature infant group.