Lung ultrasound (LUS) score is predictive of the development of moderate to severe bronchopulmonary dysplasia (ms-BPD), with moderate diagnostic accuracy on the third day of life (DOL) and the seventh DOL, according to the results of a multicenter, prospective, observational diagnostic accuracy study published in the journal CHEST.
Researchers sought to examine the diagnostic accuracy of the LUS score performed in the first week of life for predicting the development of ms-BPD and whether scanning of the posterior lung fields would improve the diagnostic accuracy. They used 2 LUS aeration scores — one of which involved anterolateral lung fields (LUS score-al) only and the other adding the posterior fields (LUS score-p). All of the LUS scores were obtained at birth, on the third DOL, on the seventh DOL, on the fourteenth DOL, and on the twenty-first DOL. The diagnostic accuracy of each of the 2 scores for the prediction of ms-BPD was evaluated at each of these prespecified time points. The primary outcome was the development of ms-BPD. Secondary endpoints were any-grade BPD, days on mechanical ventilation, need for postnatal systemic corticosteroid use, and hospital discharge on supplemental oxygen.
The current analysis included a total of 832 LUS examinations that involved 298 patients. The median birth weight and gestational age of the infants enrolled in the study were 1100 grams (range, 859-1340 grams) and 29 weeks (range, 26-30 weeks). In all, 58% of the participants were male. Overall, ms-BPD was diagnosed in 24.5% (73 of 298) of the infants, 63% of whom had a gestational age of less than 28 weeks.
The median number of LUS examinations per participant was 4 (interquartile range, 2-4). The LUS score-al and the LUS score-p, adjusted either according to gestational age or to postnatal age, were highly correlated (r =.97 and P <.001 in both instances). The LUS score-al and the LUS score-p were both significantly higher among infants who developed ms-BPD than in the rest of the cohort at every time point (P <.001). LUS scores on the third and seventh DOL were correlated to the severity of BPD (P <.001).
Use of the LUS score-al had a moderate diagnostic accuracy to be predictive of ms-BPD on the third, seventh, fourteenth, and twenty-first DOL, with areas under the curve (AUCs) of 0.77, 0.79, 0.73, and 0.80, respectively. No significant differences were observed between the AUCs of the LUS score-al and the LUS score-p in the prediction of developing ms-BPD at birth (P =.36), at the third DOL (P =.97), at the seventh DOL (P =.26), or at the twenty-first DOL (P =.17). The LUS score-p, on the other hand, demonstrated a significantly higher AUC on the fourteenth DOL than did the LUS score-al (AUC, 0.77; 95% CI, 0.69-0.83 vs AUC, 0.73; 95% CI, 0.66-0.80, respectively; P = .01).
A major limitation of the study was the presence of uncontrolled confounding factors, including variability in respiratory and general management among the different participating centers. The investigators concluded that the addition of sex and gestational age to the LUS score enhances its diagnostic accuracy, providing a diagnostic performance that is comparable to the evaluation of multiple clinical risk factors. When the examination of posterior lung zones is added, the early prediction of ms-BPD did not appear to improve.
Alonso-Ojembarrena A, Serna-Guerediaga I, Aldecoa-Bilbao V, et al. The predictive value of lung ultrasound scores in developing bronchopulmonary dyspslasia: a prospective multicenter diagnostic accuracy study. CHEST. Published online March 6, 2021. doi:10.1016/j.chest.2021.02.066