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Prediction of respiratory distress severity and bronchopulmonary dysplasia by lung ultrasounds and transthoracic electrical bioimpedance

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Abstract

This study aims to evaluate whether the assessment of a lung ultrasound score (LUS) by lung ultrasonography and of thoracic fluid contents (TFC) by electrical cardiometry may predict RDS severity and the development of bronchopulmonary dysplasia (BPD) in preterm infants with respiratory distress (RDS). Infants ≤ 34 weeks’ gestation admitted with RDS to two neonatal intensive care units were prospectively enrolled in this observational study. A simultaneous evaluation of LUS and TFC was performed during the first 72 h. The predictivity of LUS and TFC towards mechanical ventilation (MV) need after 24 h and BPD development was evaluated using receiver operating characteristic analysis. Sixty-four infants were included. The area under the curve (AUC) for the prediction of MV need was 0.851 (95%CI, 0.776–0.925, p < 0.001) for LUS and 0.793 (95%CI, 0.724–0.862, p < 0.001) for TFC, while an AUC of 0.876 (95%CI, 0.807–0.946, p < 0.001) was obtained for combined LUS and TFC evaluation. LUS and TFC AUC for BPD prediction were 0.769 (95%CI, 0.697–0.842, p < 0.001) and 0.836 (95%CI, 0.778–0.894, p < 0.001), respectively, whereas their combined assessment yielded an AUC of 0.867 (95%CI, 0.814–0.919, p < 0.001). LUS ≥ 11 and TFC ≥ 40 were identified as cut-off values for MV need prediction, whereas LUS ≥ 9 and TFC ≥ 41.4 best predicted BPD development.

  Conclusion: A combined evaluation of LUS and TFC by lung ultrasonography and EC during the first 72 h may represent a useful predictive tool towards short- and medium-term pulmonary outcomes in preterm infants with RDS.

What is Known:

• Lung ultrasonography is largely used in neonatal intensive care and can contribute to RDS diagnosis in preterm infants.

• Little is known on the diagnostic and predictive role of TFC, measured by transthoracic electrical bioimpedance, in neonatal RDS.

What is New:

• Combining lung ultrasonography and TFC evaluation during the first 72 h can improve the prediction of RDS severity and BPD development in preterm infants with RDS and may aid to establish tailored respiratory approaches to improve these outcomes.

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Availability of data and material

Data are available from the corresponding author upon reasonable request.

Code availability

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Abbreviations

AUC:

Area under the curve

BPD:

Bronchopulmonary dysplasia

CI:

Confidence interval

EC:

Electrical cardiometry

GA:

Gestational age

LR:

Likelihood ratio

LUS:

Lung ultrasound score

NPV:

Negative predictive value

PPV:

Positive predictive value

RDS:

Respiratory distress

ROC:

Receiving operator characteristic

TFC:

Thoracic fluid contents

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Author information

Author notes

  1. Silvia Martini and Italo Francesco Gatelli contributed equally as co-first authors.

  2. Stefano Martinelli and Luigi Corvaglia contributed equally as co-senior authors.

Authors and Affiliations

  1. Neonatal Intensive Care Unit, IRCCS AOU S. Orsola, Bologna, Italy

    Silvia Martini, Silvia Galletti, Federica Camela & Luigi Corvaglia

  2. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Silvia Martini, Silvia Galletti, Federica Camela & Luigi Corvaglia

  3. Division of Neonatology and Neonatal Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Italo Francesco Gatelli, Ottavio Vitelli, Francesca De Rienzo & Stefano Martinelli

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  1. Silvia Martini
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Contributions

Silvia Martini, Italo Gatelli, Silvia Galletti, Stefano Martinelli and Luigi Corvaglia conceived and designed the study. Data collection was performed by Italo Gatelli, Silvia Martini, Ottavio Vitelli, Federica Camela and Francesca De Rienzo. Data analysis was performed by Silvia Martini. The first draft of the manuscript was written by Silvia Martini and Italo Gatelli; Ottavio Vitelli contributed to the draft writing. Silvia Galletti, Federica Camela, Francesca De Rienzo, Stefano Martinelli and Luigi Corvaglia critically revised the manuscript. All authors have read and approved the submitted version of the manuscript.

Corresponding author

Correspondence to Silvia Martini.

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Ethics approval

The study protocol was approved by the local ethic committees (Area Vasta Emilia Centro (AVEC), approval ID 092/201/Oss/AOUBo; Comitato Etico Milano Area 3, approval ID 48-12022020).

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The consent for participation was obtained from the parents or legal guardians of the enrolled infants.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Martini, S., Gatelli, I.F., Vitelli, O. et al. Prediction of respiratory distress severity and bronchopulmonary dysplasia by lung ultrasounds and transthoracic electrical bioimpedance. Eur J Pediatr 182, 1039–1047 (2023). https://doi.org/10.1007/s00431-022-04764-6

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