The role of the lung ultrasound in the delivery room for predicting the need for neonatal intensive care admission in neonates

The study aimed to evaluate whether early quantitative lung ultrasound findings are associated with subsequent neonatal intensive care unit (NICU) admission and early respiratory distress (RD) in late-preterm and term newborns. The study was a single-center, prospective, observational design. Lung ultrasound (LUS) was used for all inborn late preterm and term neonates. A total of 4 LUSs were performed in the first 24 hours of life (within the first 30 minutes and at 2, 6 and 24 hours) for neonates who did not require NICU admission. For cases requiring NICU admission, 5th LUS was performed at 72 hours. Infants in need of NICU admission were divided into two sub-groups, with RD and without RD. A total of 149 newborns were admitted in the study. In NICU-admitted group, the median values of right, left and total LUS aeration scores were significantly higher within the first 30 minutes, at 2 nd , 6th and 24th hours compared to non-NICU admission group. In RD group, the median values of total LUS were significantly higher within the first 30 minutes, at 2nd and at 6th hours. The cut-off scores for predicting NICU admission were 6 (61% sensitivity, 76% specificity) and 3 (68% sensitivity, 63% specificity) for LUS aeration score within the first 30 minutes and at the 2nd hour, respectively. Neonates with coalescent B-lines on LUS within the first 30 minutes and at 2nd hour had a 3.6- and 10.8-times increased risk of NICU admission, respectively, compared to those with only B-lines. The prediction of NICU admission based on combined LUS aeration score and LUS assessment within the first 30 minutes had a sensitivity of 67.7% and specificity of 67.8. The prediction of RD based on combined LUS aeration score and LUS assessment within the first 30 minutes had a sensitivity of 52.6%, and specificity of 100%. Early LUS aeration score values were higher in neonates needing NICU admission. The presence of coalescent B-lines on LUS aeration score increased the risk of NICU admission. When combined with quantitative LUS findings, the LUS aeration score was associated with improved specificity for identifying neonates at higher risk of RD in the early period, supporting its potential use for early risk stratification.