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Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants

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Abstract

Lung ultrasound (LU) has emerged as the imaging technique of choice for the assessment of neonates with respiratory distress syndrome (RDS) at the bedside. Scoring systems were developed to quantify RDS severity and to predict the need for surfactant administration. There is no data on the comparison of the three main LU scores (LUS) proposed by Brat, Raimondi and Rodriguez-Fanjul. Moreover, there is not enough evidence to recommend which score and which cut-off has the best ability to predict surfactant need. The three LUS were compared in terms of ability to predict the need for surfactant and reproducibility in a cohort of very preterm infants. This was an observational, retrospective, multicenter study. Neonates below 32 weeks of gestational age with RDS, on non-invasive ventilation with a LU performed prior to surfactant administration (1–3 h of life) were included. Brat, Raimondi, and Rodriguez-Fanjul’s scores were calculated for each patient. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability to predict surfactant administration. K-Cohen test, Bland–Altman, and intraclass correlation coefficients were used to assess the intra and interobserver variability. Fifty-four preterm infants were enrolled. Brat, Raimondi, and Rodriguez-Fanjul scores showed a strong ability to predict the need for surfactant: the AUCs were 0.85 (95% CI 0.74–0.96), 0.85 (95% CI 0.75–0.96), and 0.79 (95% CI 0.67–0.92), respectively. No significant differences have been found between the AUCs using the DeLong test. Brat and Raimondi’s scores had an optimal cut-off value > 8, while the Rodriguez-Fanjul’s score > 10. The k-Cohen values of intraobserver agreement for Brat, Raimondi, and Rodriguez-Fanjul’s scores were 0.896 (0.698–1.000), 1.000 (1.000–1.000), and 0.922 (0.767–1.000), respectively. The k-Cohen values of interobserver agreement were 0.896 (0.698–1.000), 0.911 (0.741–1.000), and 0.833 (0.612–1.000), respectively.

Conclusions: The three LUS had an excellent ability to predict the need for surfactant and an optimal intra and interobserver agreement. The differences found between the three scores are minimal with negligible clinical implications. Since the optimal cut-off value differed, the same score should be used consistently within the same center.

What is Known:

• Lung ultrasound is a useful bedside imaging tool that should be used in the assessment of neonates with RDS

• Scoring systems or lung ultrasound scores allow to quantify the severity of the pulmonary disease and to predict the need for surfactant replacement therapy

What is New:

• The three lung ultrasound scores by Brat, Raimondi and Rodriguez-Fanjul have an excellent ability to predict the need for surfactant replacement therapy, although with different cut-off values

• All three lung ultrasound scores had an excellent intra and interobserver reproducibility

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Neonatal Intensive Care Unit, Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy

    Iuri Corsini, Martina Ciarcià, Monica Fusco & Carlo Dani

  2. Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy

    Maria Beatrice Lenzi, Enrico Petoello, Alice Iride Flore, Silvia Nogara & Benjamim Ficial

  3. Neonatal Intensive Care Unit, Hospital Cervello Palermo, Palermo, Italy

    Federico Matina & Antonella Gangemi

  4. Division of Neonatology, Department of Translational Medical Sciences, Università Federico II di Napoli, Naples, Italy

    Letizia Capasso & Francesco Raimondi

  5. Neonatology Department, Institut d’Investigació Germans Trias i Pujol (IGTP), Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain

    Javier Rodriguez-Fanjul

  6. Department of Neurosciences, Drug Research and Child Health, University of Florence, PsychologyFlorence, Italy

    Carlo Dani

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  1. Iuri Corsini
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Contributions

Conceptualization: B.F., I.C., F.M., C.D.; data curation: B.F., I.C., M.B.L., M.C., E.P., A.I.F., S.N., M.F.; methodology: B.F., I.C., M.C., L.C., J.R.F., A.G; supervision: I.C., B.F., M.C., F.R., C.D.; writing—original draft: B.F., I.C.; writing—review and editing: I.C., M.B.L., M.C., F.M., E.P., A.I.F., S.N., A.G., M.F., L.C., F.R., J.R.F., C.D., and B.F. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Iuri Corsini.

Ethics declarations

Competing interests

IC received lecture fees from Chiesi farmaceutici. CD received honoraria from Chiesi Farmaceutici Spa and Vyaire Medical Inc. for scientific consultancy. All the other Authors has nothing to declare

Ethics approval

The study was approved by the Tuscany Paediatric Regional Ethics Committee approved the study (n 131/2023). The parents or guardians of babies enrolled gave their written informed consent. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Competing interest

IC received lecture fees from Chiesi farmaceutici. CD received honoraria from Chiesi Farmaceutici Spa and Vyaire Medical Inc. for scientific consultancy. All the other authors has nothing to declare.

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Communicated by Daniele De Luca

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Corsini, I., Lenzi, M.B., Ciarcià, M. et al. Comparison among three lung ultrasound scores used to predict the need for surfactant replacement therapy: a retrospective diagnostic accuracy study in a cohort of preterm infants. Eur J Pediatr 182, 5375–5383 (2023). https://doi.org/10.1007/s00431-023-05200-z

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