Diagnostic utility of bedside ‘Point of Care Lung Ultrasound’ in
Predicting the need for NICU admission in late preterm and term newborns
having respiratory distress soon after birth in the transition period.
Abstract
Background: Point of care Lung ultrasound (POC-LUS) is a rapid
and simple method to evaluate neonates with respiratory distress.
POC-LUS has lately been reported as a predictor of need for NICU
admission in late preterm and term babies born with respiratory distress
in the transition period. Objectives: The Primary objective was
to determine whether the POC-LUS score is a good predictor for need for
NICU admission in late preterm and term babies born with respiratory
distress when performed within the first 2 hours of life. The secondary
objective was to find a correlation between the LUS score and the
clinical respiratory distress severity score during this transition
period. Methods: A prospective observational study was carried
out in a tertiary care neonatal unit (Level III-B) over 1 year on 97
late preterm and term neonates having respiratory distress at birth.
POC-LUS was performed in a transition nursery area within 2 hours of
birth and LUS Score was recorded as per a pre-validated LUS scoring
system. The decision for NICU admission was independently taken by the
medical team based on clinical criteria, and blinded to the LUS
findings. A receiver operating characteristic (ROC) curve was generated
to predict NICU admission based on the LUS score. LUS score was also
analyzed for correlation with clinical respiratory distress severity
scoring i.e Silverman Anderson Score (SA score) during transition.
Results: The mean gestational age of the babies in the study
was 37.45 weeks ± 1.88 weeks. 43 percent of neonates in the studied
population needed admission to the NICU. LUS Score >5/18
within 2 hours after birth as a ‘cut-off’ was determined to be an
excellent predictor of NICU admission in late preterm and term babies
who are born with respiratory distress. (Area under ROC Curve 0.903,
sensitivity 64%, specificity 98%, positive likelihood ratio 35 and
p-value <0.001). LUS score also had a positive correlation with
the SA score in the study population (Pearson correlation, r = 0.325;
p-value = 0.001). Conclusion: The study predicted an optimal
LUS score cutoff of 5/18 in deciding the need for NICU admission of late
preterm and term neonates with respiratory distress at birth and also
has a positive correlation with clinical respiratory distress score.