Observational studyBMC pediatrics2026
Lung ultrasound for neonatal respiratory distress in a resource-limited county hospital: a pilot study.
Observational study in BMC pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
backgroundWhile tertiary centers have widely adopted lung ultrasound (LUS) as a diagnostic alternative to chest X-ray (CXR), recent evidence emphasizes its growing prognostic utility. This pilot study investigated the feasibility and clinical utility of LUS aeration scores in triage decisions within a resource-limited county-level hospital.
methodsThis prospective pilot observational study enrolled neonates exhibiting signs of respiratory distress within 24 h of birth, employing a symptom-driven approach without predefined gestational age restrictions. Bedside LUS and CXR were performed within the first two hours of non-invasive respiratory support, prior to surfactant administration. LUS aeration scores were calculated using a standardized six-zone protocol (score range: 0–18). Following respiratory distress syndrome (RDS) diagnosis based on clinical and sonographic criteria, we evaluated the predictive performance of a predefined high-risk threshold (LUS aeration score ≥ 10) for triage outcomes (transferred vs. locally managed).
resultsA total of 34 neonates (gestational age range: 30 to 40 + 2 weeks) were enrolled, of whom 17 (50%) were diagnosed with RDS based on composite clinical and sonographic criteria. Within the RDS subgroup, 6 neonates (35%) required tertiary transfer due to severe clinical progression (e.g., requirement for invasive mechanical ventilation), while 11 (65%) were successfully managed locally. Transferred neonates showed a non-significant trend toward higher baseline LUS aeration scores than locally managed peers (median 12 vs. 10, P = 0.242). However, when applying a predefined threshold (LUS aeration score ≥ 10), the score yielded a sensitivity of 83.3% and a negative predictive value (NPV) of 80.0% for predicting tertiary transfer.
conclusionsBedside LUS is a feasible tool for assessing the severity of neonatal respiratory distress in resource-limited settings. Specifically, the promising negative predictive value of the LUS aeration score provides an objective basis and clinical confidence for managing low-risk neonates locally, thereby optimizing regional healthcare resources. Further large-scale studies are needed to validate these preliminary findings.
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