Beyond B lines: role of pleural line thickness in a novel thoracic ultrasound score for predicting surfactant requirement in preterm neonates
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261538Keywords:
Lung ultrasound, Pleural line thickness, Preterm neonates, Thoracic ultrasound scoreAbstract
Background: Lung ultrasound is a valuable tool for assessing neonatal respiratory distress. Standard lung ultrasound scores (LUS) quantify B-lines, but the role of pleural line thickness, a potential marker of pulmonary edema and inflammation, is less explored. Objective was to assess the diagnostic accuracy of a novel thoracic ultrasound score (TUS), which includes pleural line thickness, in evaluating oxygenation and predicting surfactant need in preterm neonates, compared to the standard LUS.
Methods: This prospective study included 80 preterm neonates. After stabilization, infants underwent lung ultrasound (based on Brat et al) and thoracic ultrasound within 3 hours of life. Both the TUS and the standard LUS were calculated.
Results: Surfactant was administered to 25 infants (31.25%). These infants had lower gestational age (30.80±3.19 versus 33.56±2.35 weeks, p<0.001), higher FiO2 requirements, and worse oxygenation indices (S/F ratio: 199.96±26.00 versus 376.18±62.95, p<0.001). TUS and LUS were both significantly higher in the surfactant group (8.60±1.61 versus 3.71±1.42, p<0.001 and 10.80±1.68 versus 6.80±1.99, p<0.001, respectively). Pleural line thickness was greater in the surfactant group (1.42±0.15 mm versus 0.99±0.30 mm, p<0.001). For predicting surfactant need, the optimal TUS cut-off was 5 (sensitivity 96%, specificity 92.73%) and LUS cut-off was 9 (sensitivity 92%, specificity 94.55%). In infants >34 weeks, TUS showed sensitivity (100%) and NPV (100%). Both scores demonstrated strong correlations with OSI (TUS: r=0.77; LUS: r=0.71, p<0.001) and S/F ratio (TUS: r=-0.76; LUS: r=-0.72, p<0.001).
Conclusions: The thoracic ultrasound score, incorporating pleural line thickness, is feasible and accurate tool for early prediction of surfactant need and correlates strongly with oxygenation status in preterm neonates. It performs exceptionally well, particularly in near-term infants.
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