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Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration

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Abstract

Purpose

Concerns remain on different alveolar deposition of surfactant between LISA and INSURE methods. Ultrasound evaluation of diaphragm kinetics may provide clinical evidence on this issue, as indirect representation of the respiratory system compliance.

Methods

This was a prospective-observational pilot study. The inclusion criterion was CPAP-supported infants ≤ 32 weeks with RDS receiving surfactant via minimally invasive technique. 52 patients randomized for surfactant administration via LISA or INSURE methods were enrolled. Right diaphragm (RD) global mean peak velocity (MPV) by Pulsed-Wave Tissue Doppler Imaging (PTDI) was recorded before and two hours after surfactant administration with simultaneous measurements of oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF ratio). Mechanical ventilation ≤ 72 h from birth represented treatment failure.

Results

LISA infants had significantly higher gestational age (p = 0.029) and birth weight (p = 0.030) with lower CRIB-II scores (p = 0.030) than INSURE infants. LISA infants showed higher median MPV at baseline RD-PTDI US assessment (p = 0.024), but post-surfactant median MPV and other the investigated variables were similar at the adjusted analysis for gestational age and sedation. 8/52 (15%) infants who failed treatment had a significantly lower SF ratio (p = 0.002) and higher median MPV at RD-PTDI US (p = 0.004) after surfactant administration, despite the higher CPAP support level before (p = 0.007) and after (p = 0.001) surfactant administration. A full course of antenatal steroids was protective against mechanical ventilation (p = 0.038).

Conclusions

Different minimally invasive surfactant administration techniques do not appear to influence diaphragm kinetics evaluated by RD-PTDI US.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at: https://docs.google.com/spreadsheets/d/1z3Gil-uTw5rPDAwlTnWaL_I4Mr_ggwNh/edit?usp=sharing&ouid=108672324634995930721&rtpof=true&sd=true.

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Acknowledgements

We thank the neonatal intensive care unit staff for their valuable contribution.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors did not receive any funds for this study.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit and Neonatal Pathology, S. Maria Della Misericordia Hospital, Piazzale Giorgio Menghini 1, 06129, Perugia, Italy

    Maurizio Radicioni, Ambra Fantauzzi & Piergiorgio Camerini

  2. Pediatric Clinic, University of Perugia, Perugia, Italy

    Serena Pennoni

  3. Department of Medicine, University of Perugia, Perugia, Italy

    Vittorio Bini

Authors
  1. Maurizio Radicioni
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  2. Serena Pennoni
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  3. Ambra Fantauzzi
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  4. Vittorio Bini
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  5. Piergiorgio Camerini
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Contributions

All authors made a substantial contribution to the concept and design of the work. MR, SP and PC drafted the manuscript, designed the data collection instruments, performed exams, collected as well as interpreted data, and critically revised the manuscript for important intellectual content. AF helped in the collection and interpretation of data, gave administrative, technical, and material support, and critically revised the manuscript for important intellectual content. MR and VB conceptualized, designed, coordinated, and supervised the study, performed the data analysis and interpretation, and critically reviewed. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Maurizio Radicioni.

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Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Ethical approval

This study was conducted following the ethical standards of the Ethical Committee of the Health Authorities of the Umbria Region—CER [study code: MOV PG-04; CER registration number: 3800/19] and with the Helsinki Declaration of 1975.

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All patients’ parents/caregivers and healthcare professionals have signed a written informed consent.

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Radicioni, M., Pennoni, S., Fantauzzi, A. et al. Ultrasound evaluation of diaphragm kinetics after minimally invasive surfactant administration. J Ultrasound 27, 87–96 (2024). https://doi.org/10.1007/s40477-023-00820-5

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  • DOI: https://doi.org/10.1007/s40477-023-00820-5

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