Use of neonatal chest ultrasound to predict noninvasive ventilation failure

• Published in: Pediatrics (Evanston) 2014-10, Vol.134 (4), p.e1089-e1094
• Main Authors: Raimondi, Francesco, Migliaro, Fiorella, Sodano, Angela, Ferrara, Teresa, Lama, Silvia, Vallone, Gianfranco, Capasso, Letizia
• Format: Article
• Language: English
• Subjects: Continuous Positive Airway Pressure - adverse effects; Continuous Positive Airway Pressure - methods; Failure analysis; Female; Health aspects; Humans; Infant, Newborn; Infants (Newborn); Lung - diagnostic imaging; Male; Medical examination; Medical treatment; Methods; Neonatal screening; Newborn babies; Noninvasive Ventilation - adverse effects; Noninvasive Ventilation - methods; Pediatrics; Predictive Value of Tests; Radiography; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - diagnostic imaging; Respiratory Distress Syndrome, Newborn - therapy; Respiratory system tests; Single-Blind Method; Treatment Failure; Ultrasonic imaging; Ultrasonography; Ventilation
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2013-3924

Noninvasive ventilation is the treatment of choice for neonatal moderate respiratory distress (RD). Predictors of nasal ventilation failure are helpful in preventing clinical deterioration. Work on neonatal lung ultrasound has shown that the persistence of a hyperechogenic, "white lung" image correlates with severe distress in the preterm infant. We investigate the persistent white lung ultrasound image as a marker of noninvasive ventilation failure. Newborns admitted to the NICU with moderate RD and stabilized on nasal continuous positive airway pressure for 120 minutes were enrolled. Lung ultrasound was performed and blindly classified as type 1 (white lung), type 2 (prevalence of B-lines), or type 3 (prevalence of A-lines). Chest radiograph also was examined and graded by an experienced radiologist blind to the infant's clinical condition. Outcome of the study was the accuracy of bilateral type 1 to predict intubation within 24 hours from scanning. Secondary outcome was the performance of the highest radiographic grade within the same time interval. We enrolled 54 infants (gestational age 32.5 ± 2.6 weeks; birth weight 1703 ± 583 g). Type 1 lung profile showed sensitivity 88.9%, specificity 100%, positive predictive value 100%, and negative predictive value 94.7%. Chest radiograph had sensitivity 38.9%, specificity 77.8%, positive predictive value 46.7%, and negative predictive value 71.8%. After a 2-hour nasal ventilation trial, neonatal lung ultrasound is a useful predictor of the need for intubation, largely outperforming conventional radiology. Future studies should address whether including ultrasonography in the management of neonatal moderate RD confers clinical advantages.