Abstract

MPISANE-JAMA, F; BASERA, W  and  HORN, A R. Diagnostic utility of lung ultrasound in preterm neonates with respiratory distress at a tertiary neonatal intensive care unit in South Africa. S. Afr. j. child health [online]. 2025, vol.19, n.1, pp.20-26. ISSN 1999-7671.  https://doi.org/10.7196/SAJCH.2025.v19i1.2637.

BACKGROUND: Accumulating data suggest the potential for lung ultrasound (LUS) to diagnose pathology in preterm babies, but there are no published data from South Africa (SA OBJECTIVES: To describe LUS diagnoses, respiratory pathology and outcomes in preterm babies receiving non-invasive respiratory support in a tertiary SA neonatal unit, and to compare LUS with clinical diagnoses and surfactant administration METHODS: We conducted a prospective, observational study of babies at 27 - 34 weeks' gestation, with birthweight >800 g, receiving non-invasive respiratory support and who had LUS at age <3 hours. Surfactant was administered at a fraction of inspired oxygen (FiO₂) of 0.35 - 0.45 and was not influenced by LUS findings RESULTS: Fifty-one neonates were included, of whom 16% received surfactant, all with respiratory distress syndrome (RDS) as their only clinical diagnosis, compared with multiple diagnoses in the non-surfactant group, including RDS (93%), transient tachypnoea of the newborn (TTN) (16%) and pneumonia (14%). Lung ultrasound indicated less RDS in the non-surfactant group than the surfactant group (42% v. 88%; p=0.02), and more TTN (61% v. 13%; p=0.01). The LUS score (LUSS) predicted surfactant administration (area under the curve 0.8 (95% confidence interval 0.67 - 0.94)). A LUSS of 7 had the best combined sensitivity (75%) and specificity (72%) but a low positive-predictive value (33%). A LUSS of 8 identified 8 (19%; n=8/43) additional babies for surfactant who did not need treatment CONCLUSION: LUS suggested more diagnoses than clinical assessment, particularly TTN, but did not accurately predict surfactant administration at an FiO₂ of 0.35 - 0.45

Keywords : neonate; newborn; neonatal intensive care; point-of-care ultrasound; lung ultrasound; respiratory distress syndrome; surfactant.

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