COMPARISON OF SIX-AREA AND TWELVE-AREA LUNG ULTRASOUND SCORING SYSTEMS FOR PREDICTING NEED FOR MECHANICAL VENTILATION IN NEONATES WITH RESPIRATORY DISTRESS: A PROSPECTIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Lung ultrasound, Neonatal respiratory distress, Mechanical ventilation, LUS score
Abstract
Background
Lung ultrasound (LUS) scoring is increasingly used to evaluate respiratory distress in neonates, but the optimal LUS protocol for predicting mechanical ventilation remains uncertain. This study compared six-area and twelve-area LUS scoring systems for their ability to predict mechanical ventilation in neonates with respiratory distress.
Methods
In this prospective observational study, N = 90 neonates with respiratory distress admitted to a tertiary NICU were evaluated within 6 hours of admission. Standardized LUS was performed using both six-area and twelve-area protocols by trained neonatologists blinded to clinical and FiO₂ data. Clinical parameters, Silverman–Anderson scores, and FiO₂ requirements were recorded. Infants were followed for 72 hours to document mechanical ventilation requirement. Predictive accuracy was assessed using receiver-operating characteristic (ROC) curves and compared using the DeLong method.
RESULTS
Of 90 neonates, 32 (35.6%) required mechanical ventilation. Ventilated infants had significantly lower gestational age (32.1 ± 3.4 weeks vs 34.2 ± 2.8 weeks, p = 0.02), lower birth weight (1.62 ± 0.43 kg vs 1.94 ± 0.48 kg, p = 0.01), and higher FiO₂ requirement (p < 0.001). Mean six-area and twelve-area LUS scores were significantly higher in ventilated neonates (12.8 ± 2.9 and 22.6 ± 3.9) compared with non-ventilated neonates (7.3 ± 2.4 and 10.5 ± 3.3; both p < 0.001). ROC analysis showed AUC = 0.87 [95% CI 0.79–0.95] for the six-area and AUC = 0.93 [95% CI 0.87–0.98] for the twelve-area protocol. A twelve-area LUS ≥ 16 predicted mechanical ventilation with 89% sensitivity and 91% specificity. High-score infants had longer oxygen use, prolonged NICU stay, and higher mortality.
CONCLUSIONS
Both six-area and twelve-area LUS scoring systems reliably predict the need for mechanical ventilation in neonatal respiratory distress. The twelve-area protocol may facilitate earlier identification of infants needing intensive support and guide timely intervention.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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Dr. Swamy Naidu Dasari
DM (Neonatology), Assistant Professor, Department of Pediatrics, Great Eastern Medical School & Hospital, Srikakulam, India
Dr. Vinod Kumar Kuramana
DNB (Pediatrics), Associate Professor, Department of Pediatrics, Great Eastern Medical School & Hospital, Srikakulam, India
Dr. Sravana DurgaModalavalasa
MD (Pediatrics), Assistant Professor, Department of Pediatrics, Great Eastern Medical School & Hospital, Srikakulam, India