Early assessment of lung aeration using an ultrasound score as a biomarker of developing bronchopulmonary dysplasia: a prospective observational study

Ignacio Oulego-Erroz, Paula Alonso-Quintela, Sandra Terroba-Seara, Aquilina Jiménez-González, Silvia Rodríguez-Blanco, Ignacio Oulego-Erroz, Paula Alonso-Quintela, Sandra Terroba-Seara, Aquilina Jiménez-González, Silvia Rodríguez-Blanco

Abstract

The objective of this study was to assess the predictive value of a lung ultrasound (LUS) score in the development of moderate-severe bronchopulmonary dysplasia (sBPD). This was a prospective observational diagnostic accuracy study in a third-level neonatal intensive care unit. Preterm infants with a gestational age below 32 weeks were included. A LUS score (range 0-24 points) was calculated by assessing aeration semiquantitatively (0-3 points) in eight lung zones on the 7th day of life (DOL) and repeated on the 28th DOL. ROC curves and logistic regression were used for analysis. Forty-two preterm infants were included. The LUS on the 7th DOL had an area under the receiver operating characteristic curve (AUROC) of 0.94 (95% CI: 0.87-1) for the prediction of sBPD (optimal cutoff of ≥8 points: sensitivity 93%, specificity 91%). The LUS score was independently associated with sBPD [OR 2.1 (95% CI: 1.1-3.9), p = 0.022, for each additional point in the score]. Conclusions: Lung aeration as assessed by LUS on the 7th DOL may predict the development of sBPD.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1. Scanning protocol with aeration patterns…
Fig. 1. Scanning protocol with aeration patterns and assigned punctuation for calculation of the LUS score.
a Eight-zone scanning protocol. 1: anterosuperior (midclavicular line); 2 anterolateral (anterior axillary line); 3: posterolateral (posterior axillary line); 4: posterior (paravertebral). b Aeration pattern and assigned punctuations. 0 point (normally aerated lung with A line pattern), 1 point (mild interstitial syndrome with nonconfluent B-line pattern); 2 points (severe interstitial syndrome with confluent B-line pattern “white lung”); 3 point (extent lung consolidation).
Fig. 2. Flow chart of the study.
Fig. 2. Flow chart of the study.
DOL day of life, PMA postmenstrual age.
Fig. 3. Lung ultrasound score accorging to…
Fig. 3. Lung ultrasound score accorging to bronchopulmonary dysplasia grade at 36 weeks of postmenstrual age.
Lung Ultrasound Score on the 7th (a) and 28th day of life (b) An asterisk indicates Jonckheere-Terpstra trend test.

References

    1. Cheong JLY, Doyle LW. An update on pulmonary and neurodevelopmental outcomes of bronchopulmonary dysplasia. Semin Perinatol. 2018;42:478–84. doi: 10.1053/j.semperi.2018.09.013.
    1. Lui K, Lee SK, Kusuda S, Adams M, Vento M, Reichman B, et al. Trends in outcomes for neonates born very preterm and very low birth weight in 11 high-income countries. J Pediatr. 2019;215:32–40. doi: 10.1016/j.jpeds.2019.08.020.
    1. Webbe JWH, Duffy JMN, Afonso E, Al-Muzaffar I, Brunton G, Greenough A, et al. Core outcomes in neonatology: development of a core outcome set for neonatal research. Arch Dis Child Fetal Neonatal Ed. 2019. 10.1136/archdischild-2019-317501.
    1. Bancalari E, Claure N, Sosenko IRS. Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol SN. 2003;8:63–71. doi: 10.1016/S1084-2756(02)00192-6.
    1. McEvoy CT, Jain L, Schmidt B, Abman S, Bancalari E, Aschner JL. Bronchopulmonary dysplasia: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases. Ann Am Thorac Soc. 2014;11(Suppl 3):S146–S153. doi: 10.1513/AnnalsATS.201312-424LD.
    1. McEvoy CT, Aschner JL. The natural history of bronchopulmonary dysplasia: the case for primary prevention. Clin Perinatol. 2015;42:911–31. doi: 10.1016/j.clp.2015.08.014.
    1. Askie LM, Ballard RA, Cutter GR, Dani C, Elbourne D, Field D, et al. Inhaled nitric oxide in preterm infants: an individual-patient data meta-analysis of randomized trials. Pediatrics. 2011;128:729–39. doi: 10.1542/peds.2010-2725.
    1. Davis JM, Parad RB, Michele T, Allred E, Price A, Rosenfeld W, et al. Pulmonary outcome at 1 year corrected age in premature infants treated at birth with recombinant human CuZn superoxide dismutase. Pediatrics. 2003;111:469–76. doi: 10.1542/peds.111.3.469.
    1. Dunn MS, Kaempf J, de Klerk A, de Klerk R, Reilly M, Howard D, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics. 2011;128:e1069–e1076. doi: 10.1542/peds.2010-3848.
    1. Onland W, Cools F, Kroon A, Rademaker K, Merkus MP, Dijk PH, et al. Effect of hydrocortisone therapy initiated 7 to 14 days after birth on mortality or bronchopulmonary dysplasia among very preterm infants receiving mechanical ventilation: a randomized clinical trial. JAMA. 2019;321:354–63. doi: 10.1001/jama.2018.21443.
    1. Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL. Early (<8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev. 2017;10:CD001146.
    1. Lal CV, Ambalavanan N. Biomarkers, early diagnosis, and clinical predictors of bronchopulmonary dysplasia. Clin Perinatol. 2015;42:739–54. doi: 10.1016/j.clp.2015.08.004.
    1. Biomarkers Definitions Working Group. Biomarkers and surrogate endpoints: preferred definitions and conceptual framework. Clin Pharmacol Ther. 2001;69:89–95. doi: 10.1067/mcp.2001.113989.
    1. Alvarez-Fuente M, Moreno L, Lopez-Ortego P, Arruza L, Avila-Alvarez A, Muro M, et al. Exploring clinical, echocardiographic and molecular biomarkers to predict bronchopulmonary dysplasia. PloS One. 2019;14:e0213210. doi: 10.1371/journal.pone.0213210.
    1. Hiles M, Culpan A-M, Watts C, Munyombwe T, Wolstenhulme S. Neonatal respiratory distress syndrome: chest X-ray or lung ultrasound? A Syst Rev Ultrasound Leeds Engl. 2017;25:80–91.
    1. De Martino L, Yousef N, Ben-Ammar R, Raimondi F, Shankar-Aguilera S, De Luca D. Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics. 2018;142. 10.1542/peds.2018-0463.
    1. Gregorio-Hernández R, Arriaga-Redondo M, Pérez-Pérez A, Ramos-Navarro C, Sánchez-Luna M. Lung ultrasound in preterm infants with respiratory distress: experience in a neonatal intensive care unit. Eur J Pediatr. 2020;179:81–89. doi: 10.1007/s00431-019-03470-0.
    1. Raschetti R, Yousef N, Vigo G, Marseglia G, Centorrino R, Ben-Ammar R, et al. Echography-guided surfactant therapy to improve timeliness of surfactant replacement: a quality improvement project. J Pediatr. 2019;212:137–143. doi: 10.1016/j.jpeds.2019.04.020.
    1. Walkup LL, Woods JC. Newer imaging techniques for bronchopulmonary dysplasia. Clin Perinatol. 2015;42:871–87. doi: 10.1016/j.clp.2015.08.012.
    1. Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically Ill patients. Am J Respir Crit Care Med. 2019;199:701–14. doi: 10.1164/rccm.201802-0236CI.
    1. Alonso-Ojembarrena A, Lubián-López SP. Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants. Pediatr Pulmonol. 2019;54:1404–9. doi: 10.1002/ppul.24410.
    1. Abdelmawla M, Louis D, Narvey M, Elsayed Y. A lung ultrasound severity score predicts chronic lung disease in preterm infants. Am J Perinatol. 2019;36:1357–61. doi: 10.1055/s-0038-1676975.
    1. Laughon MM, Langer JC, Bose CL, Smith PB, Ambalavanan N, Kennedy KA, et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am J Respir Crit Care Med. 2011;183:1715–22. doi: 10.1164/rccm.201101-0055OC.
    1. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Plavka R, et al. European consensus guidelines on the management of respiratory distress syndrome—2016 update. Neonatology. 2017;111:107–25. doi: 10.1159/000448985.
    1. Sweet DG, Carnielli V, Greisen G, Hallman M, Ozek E, Te Pas A, et al. European consensus guidelines on the management of respiratory distress syndrome—2019 update. Neonatology. 2019;115:432–50. doi: 10.1159/000499361.
    1. Rodríguez-Blanco S, Oulego-Erroz I, Alonso-Quintela P, Terroba-Seara S, Jiménez-González A, Palau-Benavides M. N-terminal-probrain natriuretic peptide as a biomarker of moderate to severe bronchopulmonary dysplasia in preterm infants: a prospective observational study. Pediatr Pulmonol. 2018;53:1073–81. doi: 10.1002/ppul.24053.
    1. Brat R, Yousef N, Klifa R, Reynaud S, Shankar Aguilera S, De Luca D. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr. 2015;169:e151797. doi: 10.1001/jamapediatrics.2015.1797.
    1. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9. doi: 10.1164/ajrccm.163.7.2011060.
    1. Sharma D, Farahbakhsh N. Role of chest ultrasound in neonatal lung disease: a review of current evidences. J Matern-Fetal Neonatal Med J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2019;32:310–6.
    1. Álvarez-Fuente M, Moreno L, Mitchell JA, Reiss IK, Lopez P, Elorza D, et al. Preventing bronchopulmonary dysplasia: new tools for an old challenge. Pediatr Res. 2019;85:432–41. doi: 10.1038/s41390-018-0228-0.
    1. Förster K, Sass S, Ehrhardt H, Mous DS, Rottier RJ, Oak P, et al. Early identification of bronchopulmonary dysplasia using novel biomarkers by proteomic screening. Am J Respir Crit Care Med. 2018;197:1076–80. doi: 10.1164/rccm.201706-1218LE.
    1. Rivera L, Siddaiah R, Oji-Mmuo C, Silveyra GR, Silveyra P. Biomarkers for bronchopulmonary dysplasia in the preterm infant. Front Pediatr. 2016;4:33. doi: 10.3389/fped.2016.00033.
    1. Bueno-Campaña M, Sainz T, Alba M, Del Rosal T, Mendez-Echevarría A, Echevarria R, et al. Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: a cohort study. Pediatr Pulmonol. 2019;54:873–80. doi: 10.1002/ppul.24287.
    1. Zoido Garrote E, García Aparicio C, Camila Torrez Villarroel C, Pedro Vega García A, Muñiz Fontán M, Oulego Erroz I. Usefulness of early lung ultrasound in acute mild-moderate acute bronchiolitis. a pilot study. An Pediatr. 2019;90:10–18. doi: 10.1016/j.anpedi.2018.03.002.
    1. Bello G, Blanco P. Lung ultrasonography for assessing lung aeration in acute respiratory distress syndrome: a narrative review. J Ultrasound Med J Am Inst Ultrasound Med. 2019;38:27–37. doi: 10.1002/jum.14671.
    1. Chiumello D, Umbrello M, Sferrazza Papa GF, Angileri A, Gurgitano M, Formenti P, et al. Global and regional diagnostic accuracy of lung ultrasound compared to CT in patients with acute respiratory distress syndrome. Crit Care Med. 2019;47:1599–606. doi: 10.1097/CCM.0000000000003971.
    1. Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL. Early (< 8 days) systemicpostnatal corticosteroids for prevention of bronchopulmonary dysplasia inpreterm infants. Cochrane Database Syst Rev. 2017;24:10.
    1. Morris IP, Goel N, Chakraborty M. Efficacy and safety of systemic hydrocortisone for the prevention of bronchopulmonary dysplasia in preterm infants: a systematic review and meta-analysis. Eur J Pediatr. 2019;178:1171–84. doi: 10.1007/s00431-019-03398-5.
    1. Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby J-J. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183:341–7. doi: 10.1164/rccm.201003-0369OC.
    1. Li LM, Li LH, Guan J, Yang Q, Han JQ, Chao YG. The value of lung ultrasound score for therapeutic effect assessment of ventilator-associated pneumonia. Zhonghua Nei Ke Za Zhi. 2016;55:950–2.

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