Lung Ultrasonography Scores Predict Respiratory Outcomes in Preterm Infants, JAMA unravels research

Preterm birth and bronchopulmonary dysplasia (BPD) frequently lead to poor respiratory outcomes and frequent exacerbations. Growing evidence supports using LUS to estimate BPD risk, but its association with later respiratory outcomes was unknown until this study. The Province of Padua Ethics Committee for Clinical Trials approved the study, and parents provided written informed consent.

The objective was to evaluate the association between LUS within the first 3, 7, and 14 days of life (DOL) and respiratory outcomes, such as exacerbations, wheezing episodes, and medication use, at 2 years' corrected age. This multicenter, prospective study enrolled 51 preterm infants (<30 weeks' gestation) between September 2019 and November 2022. Clinical data and validated respiratory morbidity scores were collected. LUS was evaluated as a risk factor for respiratory outcomes using area under the receiver operating characteristic curve (AUC) analysis. Statistical analysis was performed with IBM SPSS Statistics 28.0.1, with two-sided P < .05 indicating statistical significance.

• The mean gestational age was 27.3 ± 1.7 weeks; 39.2% were female, 60.8% male. The mean birth weight was 947 ± 301 grams.

• 16 infants (31%) developed moderate to severe BPD, and 8 (16%) developed mild BPD.

• Post-discharge, 32 infants (63%) received at least one respiratory drug, 16 (31%) were hospitalized for respiratory problems, and 3 (6%) needed pediatric ICU admission.

• The mean respiratory morbidity score at 2 years was 0.51 ± 0.76.

• Infants needing respiratory drugs had higher median LUS at DOL 3 (1 [0-3] vs 6 [3-10]; P = .02), DOL 7 (0 [0-1] vs 5 [2-10]; P < .001), and DOL 14 (1 [0-2] vs 6 [1-11]; P < .001). Higher LUS at DOL 3 (3 [0-7] vs 4 [3-12]; P < .001), DOL 7 (1 [0-4] vs 10 [5-12]; P < .001), and DOL 14 (2 [0-3] vs 8 [7-12]; P < .001) was also observed in infants needing hospitalization. Infants needing ICU had LUS over 8 consistently.

• At DOL 7, LUS correlated with the number of respiratory exacerbations needing drugs (ρ = 0.762) or hospitalization (ρ = 0.663) and with the respiratory morbidity score (ρ = 0.714).

• Adjusted analyses for gestational age showed significant results for DOL 7 and 14 (e.g., needing drugs: adjusted β = 0.352 and 0.177).

• AUC analysis showed significant associations at DOL 7 (0.838 for needing drugs and 0.868 for needing hospitalizations).

The study highlights the importance of respiratory outcomes in the first 2 years of life for preterm infants with BPD. A higher LUS within the first 14 days is a risk factor for more frequent respiratory episodes. LUS at DOL 7 and 14, especially, showed strong correlations with the need for respiratory medications and hospitalizations, suggesting that this time frame is critical for predicting long-term outcomes.

The study demonstrates that LUS within the first 14 days of life is a predictive tool for respiratory outcomes in preterm infants. The study's findings support the use of LUS to guide early interventions, potentially improving long-term respiratory health in this vulnerable population.

Reference:

Bonadies, L., De Luca, D., Auciello, M., Moschino, L., Congedi, S., Nardo, D., & Baraldi, E. (2024). Lung ultrasonography scores in preterm infants and respiratory outcomes at age 2 years. JAMA Network Open, 7(6), e2415513. https://doi.org/10.1001/jamanetworkopen.2024.15513