Lung ultrasound for predicting surfactant administration in ventilated and non-ventilated infants with respiratory distress syndrome: a multicenter prospective study.

This study aims to assess the utility of lung ultrasound (LUS) aeration score in predicting the need for surfactant administration in preterm infants based on surfactant deficiency and respiratory distress syndrome (RDS) severity, including its usefulness in mechanically ventilated infants. We conducted a multicenter prospective observational study. Preterm infants with respiratory distress were enrolled. LUS aeration scores were assigned based on a 6-zone system (maximum score: 18). Surfactant administration was based on stable microbubble rating and chest radiography. Infants were stratified into mechanical ventilation (MV) and noninvasive positive pressure ventilation (NIPPV) groups for analysis. Among 206 preterm infants, 80 were managed with MV and 126 with NIPPV, with surfactant administered to 48 and 27 infants, respectively. In the MV group, the LUS aeration score predicted surfactant administration with an area under the curve of 0.975 (cutoff 9; sensitivity 97.9%; specificity 96.9%). In the NIPPV group, the area under the curve was 0.915 (cutoff 8; sensitivity 84.6%; specificity 89.0%). LUS aeration score was significantly correlated with stable microbubble rating (Kendall's τ-b =  - 0.529, P < 0.001) and chest radiographic severity (Kendall's τ-b = 0.535, P < 0.001). The oxygen saturation/inspired oxygen fraction ratio improved significantly after surfactant administration in both groups.

conclusionLUS aeration score can be valuable in predicting the need for surfactant administration, even in management strategies based on surfactant deficiency and RDS severity. Furthermore, the LUS aeration score aids in predicting the need for surfactant administration in ventilated infants. WHAT IS KNOWN: • Lung ultrasound (LUS) aeration score can predict the need for surfactant in continuous positive airway pressure management, where surfactant is administered based on inspired oxygen fraction threshold. WHAT IS NEW: • LUS aeration score is useful in managing patients receiving mechanical ventilation where surfactant administration is based on surfactant deficiency and respiratory distress syndrome severity.