435 - Association of lung ultrasound score with different modes of respiratory supports and clinical outcome, an observational study in tertiary care neonatal unit.

Poster Number: 435
Publication Number: 435.227

Keshav K. Pathak, Dr. RML Hospital, New delhi, DELHI, Delhi, India; Arti Maria, India, Delhi, Delhi, India; Tapas Bandyopadhyay, ABVIMS and Dr. RML Hospital, New Delhi, Delhi, India; BHAWNA Dubey, ATAL BIHARI VAJPAYEE INSTITUTE OF MEDICAL SCIENCES, New Delhi, Delhi, India

Background: lung ultrasound is an evolving point of care tool in neonatal intensive care unit. Association of lung ultrasound (LUS) score with different modes of respiratory support can serve as a tool for monitoring respiratory status in neonates and track disease evolution.

Objective: To assess the association between LUS score and various modes of respiratory support and clinical outcomes among neonates presenting with respiratory distress

Design/Methods: this prospective cross sectional observational study was conducted in 30 bedded level III NICU. LUS score was calculated within 3 hours of receiving respiratory support in neonates presenting with respiratory distress having Downes or Silverman score more than or equal to 3. Subsequently, LUS score was assigned with each escalation and de-escalation of respiratory support. A maximum LUS score for each clinical outcome was also recorded. For calculating LUS score, each lung was divided into three areas by the anterior and posterior axillary line into the anterior, posterior and lateral areas. LUS scans were performed by the primary investigator after receiving formal training by a senior ultrasonologist for a duration of 2 months but the final LUS score assignment was given by the radiologist only to omit observer bias. Interrater agreement was determined with the intraclass correlation coefficient. Babies were provided respiratory support, surfactant and other supportive treatment according to our standard unit protocol which ensured consistency and uniformity in decision making and helped minimize possible errors in clinical judgment.

Results: Total 162 lung ultrasound scans were performed in 65 babies with mean gestation of 32.4±3.7 weeks and median (IQR) birth weight of 1480 (1130-2000) grams. LUS score [median (IQR)] of babies on CPAP, NIPPV and MV was 4 (3-6.5), 9 (8–11) and 12 (11–13.5) respectively, (p value < 0.001). The maximum median (IQR) LUS score of babies from recovery, extubation failure and death were 5.00 (3.00-8.00), 11.00 (11.00-13.00) and 12.00 (12.00-13.75) respectively, (p value < 0.001). LUS score had excellent interrater agreement (intraclass correlation coefficient - 0.998), p value < 0.001.Conclusion(s): There is an association between LUS scores and different modes of respiratory support with scores increasing as the level of support increased. LUS score was also found to be related with clinical outcomes like death, extubation failure and recovery which could help in predicting the prognosis.
baseline characteristics
patient flow chart