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Lung ultrasound predicts the development of bronchopulmonary dysplasia: a prospective observational diagnostic accuracy study

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Abstract

This study aimed to evaluate the predictive ability of lung ultrasound (LU) in the development of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. A total of 130 VLBW infants with gestational age < 32 weeks were included; LU was performed at days 1, 2, 3, 6, 9, 12, and 15 postnatally. We calculated the LU score by 12-region, 10-region, and 6-region protocols. The incidence of BPD according to the National Institutes of Health (NIH) 2001 definition and 2019 criteria was 38.5% and 64.6%, respectively. By 12-region and 10-region protocols, LU predicted BPD from the 9th to 15th days of life (DOLs) regardless of the criteria used, with an area under the curve (AUC) ranging from 0.826 (95% confidence interval (CI): 0.750–0.887) to 0.877 (95% CI: 0.807–0.928). According to the 2019 BPD definition, the LU score incorporated gestational age, and invasive mechanical ventilation >6 days predicted BPD on the 6th DOL with an AUC of 0.862 (95% CI: 0.790–0.916). The 6-region protocol had significantly smaller AUC values on the 6th and 9th DOLs than the other two protocols.

Conclusion: The 12-region and 10-region LU scoring protocols are superior to the 6-region protocol in the prediction of BPD. LU can predict the development of BPD from the 9th to 15th DOLs. With the addition of clinical variables, the earliest prediction time was the 6th DOL.

What is Known:

• Bronchopulmonary dysplasia is the most common and adverse complication of prematurity. Recent four studies found that lung ultrasound score or findings predicted the development of bronchopulmonary dysplasia.

What is New:

• We present analysis by classical 6-region and the other two lung ultrasound score (10-region and 12-region) which include an assessment of the posterior lung to allow to understand what is the best score to be used. In addition, we explore whether LU-incorporated clinical variables could improve the predictive value for BPD.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

CI:

Confidence interval

IQR:

Interquartile ranges

NICU:

Neonatal intensive care unit

NPV:

Negative predictive value

PPV:

Positive predictive value

SD:

Standard deviation

Sp:

Specificity

+LR:

Positive likelihood ratio

BPD:

Bronchopulmonary dysplasia

DOL:

Day of life

LU:

Lung ultrasound

NIH:

National Institutes of Health

PMA:

Postmenstrual age

ROC:

Receiver operating characteristic

Se:

Sensitivity

VLBW:

Very low birth weight

−LR:

Negative likelihood ratio

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Acknowledgements

The authors are grateful to 2 senior sonographers for their analysis of the images and to the patients who participated in this study.

Code availability

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Funding

The study is funded by grants from the Scientific Research Foundation of the Department of Science and Technology of Jilin Province, China (Grant Number: 20190701050GH).

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Authors and Affiliations

  1. Department of Neonatology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, China

    Xiaolei Liu, Xiaoming Lv, Di Jin, Heng Li & Hui Wu

Authors
  1. Xiaolei Liu
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  2. Xiaoming Lv
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  3. Di Jin
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  4. Heng Li
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  5. Hui Wu
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Contributions

Xiaolei Liu, Xiaoming Lv, and Hui Wu designed the study. Xiaolei Liu, Xiaoming Lv, Heng Li, and Di Jin conducted the research. Xiaolei Liu and Xiaoming Lv acquired and analyzed the data. Xiaolei Liu wrote the first draft of the manuscript. Xiaoming Lv and Hui Wu critically reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hui Wu.

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Ethical approval

This study was approved by the Ethics Committee for the First Hospital of Jilin University.

Consent to participate

Written informed consent was obtained from patients’ parents included in the study.

Consent for publication

Patients’ parents signed informed consent regarding publishing their data.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Liu, X., Lv, X., Jin, D. et al. Lung ultrasound predicts the development of bronchopulmonary dysplasia: a prospective observational diagnostic accuracy study. Eur J Pediatr 180, 2781–2789 (2021). https://doi.org/10.1007/s00431-021-04021-2

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  • DOI: https://doi.org/10.1007/s00431-021-04021-2

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