Lung Ultrasound score may be valid diagnostic tool for surfactant replacement therapy in Indian infants

A new study found that for surfactant replacement therapy in infants of 27-33 weeks gestational age, the Lung ultrasound score is a valid diagnostic tool. The study results were published in the European Journal of Pediatrics. 

Surfactant requirement in preterm infants with respiratory distress syndrome (RDS) has been traditionally based on Fraction of inspired oxygen (FiO2) criteria. Literature shows that lung ultrasound scores can predict the necessity for surfactants. As most of the studies originated in developed countries, researchers from Kolkata India, conducted a prospective diagnostic accuracy study to validate lung ultrasound score (LUS) for prediction of surfactant replacement therapy (SRT) in Indian infants of 27–33^6/7 weeks gestational age.  

The study was carried out in a level 3 neonatal care unit in India. Consecutively born preterm infants with respiratory distress syndrome (RDS) were enrolled. 78 infants with RDS were included in the final analysis. Surfactant was administered if the oxygen requirement exceeded > 30%. Baseline characteristics, respiratory parameters, and lung ultrasound images were recorded soon after admission and compared between the surfactant and non-surfactant groups. Adjusted odds ratio (OR) and diagnostic accuracy of LUS were calculated for SRT. 

Findings: 

• Among 78 RDS infants, 62 received surfactant (79.48%).
• The median time of performing lung ultrasound was 50 min of life in both surfactant and non-surfactant groups.
• The surfactant group showed a significantly higher median LUS in the anterior and posterior chest areas of either side as well as total LUS. 
• LUS was found to be a significant predictor of SRT upon adjusting for other confounders.
• Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy of LUS.
• A cutoff score of ≥ 9 for LUS was considered optimal for SRT (sensitivity: 70.97%, specificity: 68.75%).