Shiraz Badurdeen1, C Omar F Kamlin2, Sheryle R Rogerson2, Stefan C Kane3, Graeme R Polglase4, Stuart B Hooper5, Peter G Davis2, Douglas A Blank6. 1. Newborn Research Centre, The Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia; The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia. Electronic address: Shiraz.Badurdeen@thewomen.org.au. 2. Newborn Research Centre, The Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia. 3. The University of Melbourne, Department of Obstetrics and Gynaecology, Parkville, VIC 3010, Australia; Pregnancy Research Centre, Department of Maternal Fetal Medicine, The Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia. 4. The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia; Department of Obstetrics and Gynaecology, Monash University, Wellington Rd, Clayton, VIC 3800, Australia. 5. Department of Obstetrics and Gynaecology, Monash University, Wellington Rd, Clayton, VIC 3800, Australia. 6. The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright St, Clayton, VIC 3168, Australia; Monash Newborn, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC 3168, Australia.
Abstract
INTRODUCTION: Early identification of infants requiring surfactant therapy improves outcomes. We evaluated the accuracy of delivery room lung ultrasound (LUS) to predict surfactant therapy in very- and extremely preterm infants. METHODS: Infants born at <320/7 weeks were prospectively enrolled at 2 centres. LUS videos of both sides of the chest were obtained 5-10 min, 11-20 min, and 1-3 h after birth. Clinicians were masked to the results of the LUS assessment and surfactant therapy was provided according to local guidelines. LUS videos were graded blinded to clinical data. Presence of unilateral type 1 ('whiteout') LUS or worse was considered test positive. Receiver Operating Characteristic (ROC) analysis compared the accuracy of LUS and an FiO2 threshold of 0.3 to predict subsequent surfactant therapy. RESULTS: Fifty-two infants with a median age of 276/7 weeks (IQR 260/7-286/7) were studied. Thirty infants (58%) received surfactant. Area under the ROC curve (AUC) for LUS at 5-10 min, 11-20 min and 1-3 h was 0.78 (95% CI, 0.66-0.90), 0.76 (95% CI, 0.65-0.88) and 0.86 (95% CI, 0.75-0.97) respectively, outperforming FiO2 at the 5-10 min timepoint (AUC 0.45, 95% CI 0.29-0.62, p = 0.001). At 11-20 min, LUS had a specificity of 95% (95% CI 77-100%) and sensitivity of 59% (95% CI, 39-77%) to predict surfactant therapy. All infants born at 23-276/7 weeks with LUS test positive received surfactant. Twenty-six infants (50%) had worsening of LUS grades on serial assessment. CONCLUSIONS: LUS in the delivery room and accurately predicts surfactant therapy in infants <320/7 weeks.
INTRODUCTION: Early identification of infants requiring surfactant therapy improves outcomes. We evaluated the accuracy of delivery room lung ultrasound (LUS) to predict surfactant therapy in very- and extremely preterm infants. METHODS:Infants born at <320/7 weeks were prospectively enrolled at 2 centres. LUS videos of both sides of the chest were obtained 5-10 min, 11-20 min, and 1-3 h after birth. Clinicians were masked to the results of the LUS assessment and surfactant therapy was provided according to local guidelines. LUS videos were graded blinded to clinical data. Presence of unilateral type 1 ('whiteout') LUS or worse was considered test positive. Receiver Operating Characteristic (ROC) analysis compared the accuracy of LUS and an FiO2 threshold of 0.3 to predict subsequent surfactant therapy. RESULTS: Fifty-two infants with a median age of 276/7 weeks (IQR 260/7-286/7) were studied. Thirty infants (58%) received surfactant. Area under the ROC curve (AUC) for LUS at 5-10 min, 11-20 min and 1-3 h was 0.78 (95% CI, 0.66-0.90), 0.76 (95% CI, 0.65-0.88) and 0.86 (95% CI, 0.75-0.97) respectively, outperforming FiO2 at the 5-10 min timepoint (AUC 0.45, 95% CI 0.29-0.62, p = 0.001). At 11-20 min, LUS had a specificity of 95% (95% CI 77-100%) and sensitivity of 59% (95% CI, 39-77%) to predict surfactant therapy. All infants born at 23-276/7 weeks with LUS test positive received surfactant. Twenty-six infants (50%) had worsening of LUS grades on serial assessment. CONCLUSIONS: LUS in the delivery room and accurately predicts surfactant therapy in infants <320/7 weeks.
Authors: Arun Sett; Gillian W C Foo; Kelly R Kenna; Rebecca J Sutton; Elizabeth J Perkins; Magdy Sourial; Sheryle R Rogerson; Brett J Manley; Peter G Davis; Prue M Pereira-Fantini; David G Tingay Journal: Pediatr Res Date: 2022-09-27 Impact factor: 3.953
Authors: Emily J Pryor; Douglas A Blank; Stuart B Hooper; Kelly J Crossley; Shiraz Badurdeen; James A Pollock; Andrew V Stainsby; Linda C P Croton; Dylan W O'Connell; Christopher J Hall; Anton Maksimenko; Daniel Hausermann; Peter G Davis; Marcus J Kitchen Journal: Front Pediatr Date: 2022-09-28 Impact factor: 3.569