Beyond B lines: role of pleural line thickness in a novel thoracic ultrasound score for predicting surfactant requirement in preterm neonates

Alekhya Maguluri; Venkatesh Murthy Dammaningala Venkataramaiah; Sahana Giliyaru; Rajanish Kanduri Vishwanatha Gupta

doi:10.18203/2349-3291.ijcp20261538

Authors

Alekhya Maguluri Department of Pediatrics, Rajarajeswari Medical College and Hospital, Dr. MGR Educational and Research Institute, Bengaluru, Karnataka, India
Venkatesh Murthy Dammaningala Venkataramaiah Department of Pediatrics, Rajarajeswari Medical College and Hospital, Dr. MGR Educational and Research Institute, Bengaluru, Karnataka, India
Sahana Giliyaru Department of Pediatrics, Rajarajeswari Medical College and Hospital, Dr. MGR Educational and Research Institute, Bengaluru, Karnataka, India
Rajanish Kanduri Vishwanatha Gupta Department of Pediatrics, Rajarajeswari Medical College and Hospital, Dr. MGR Educational and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20261538

Keywords:

Lung ultrasound, Pleural line thickness, Preterm neonates, Thoracic ultrasound score

Abstract

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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