The value of bedside lung ultrasound in predicting bronchopulmonary dysplasia in premature infants_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Shuqiang ^1,2 , XIAO Tiantian ² , JU Rong ² , MA Rongchuan ² , ZHANG Xiaolong ² , XI Yufeng ² ,  DONG Wenbin ¹

1. Department of Newborn Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, P.R.China;
2. Department of Neonatology, Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, P.R.China;

Corresponding author：

DONG Wenbin, Email: dongwenbin2000@163.com

Keywords：

Premature infant; Bronchopulmonary dystrophy; Pulmonary ultrasound; Diagnosis; Predicting

DOI：

10.7507/1672-2531.202003020

Video：

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Objectives To evaluate the predicting value of bedside pulmonary ultrasound in bronchopulmonary dysplasia (BPD) in premature infants.Methods Premature infants with gestational age below 28 weeks or birth weight below 1 500 g admitted to NICU of Chengdu Women and Children’s Central Hospital from June 2018 to June 2019 were included. Pulmonary bedside ultrasound monitoring was performed on the 3^rd, 7^th, 14^th and 28^th day after admission, and the characteristic ultrasound images were recorded and scored. BPD were diagnosed by NICHD standard. The clinical data and pulmonary ultrasound data were compared and analyzed. Then diagnostic value of bedside pulmonary ultrasound in BPD of premature infants were analyzed.Results A total of 81 children involving 32 BPD and 49 non-BPD were included. The sensitivity (Sen), specificity (Spe) and area under curve (AUC) of receiver operating characteristic (ROC) of the "alveolar-interstitial syndrome" within 3 days after birth and the "fragment sign" on 28 days after birth were 81.25%, 51.02%, 0.66 and 31.25%, 97.96%, 0.65, respectively. The lung ultrasound scores in the BPD group on the 3^rd, 7^th, 14^th, and 28^th day after birth were 71.99.%, 68.39%, 0.71; 87.50%, 57.14%, 0.72; 78.13%, 73.47%, 0.76 and 56.25 %, 75.51%, 0.66. Sen, Spe and ROC AUC of comprehensive evaluation of lung ultrasound predicted the occurrence of BPD been 81.25%, 63.27%, and 0.85.Conclusions The comprehensive evaluation of combination of "alveolar interstitial syndrome" image characteristics within 3 days after birth, "fragment sign" image characteristics after 28 days, and lung ultrasound score at different times after birth can predict the premature infants with bronchopulmonary dysplasia.

Citation： GAO Shuqiang, XIAO Tiantian, JU Rong, MA Rongchuan, ZHANG Xiaolong, XI Yufeng, DONG Wenbin. The value of bedside lung ultrasound in predicting bronchopulmonary dysplasia in premature infants. Chinese Journal of Evidence-Based Medicine, 2020, 20(12): 1385-1389. doi: 10.7507/1672-2531.202003020 Copy

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2.	Anderson PJ, Doyle LW. Neurodevelopmental outcome of bronchopulmonary dysplasia. Semin Perinatol, 2006, 30(4): 227-232.
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4.	High Risk Follow-up Working Group (Kowloon Region). Neurodevelopmental outcomes of extreme-low-birth-weight infants born between 2001 and 2002. Hong Kong Med J, 2008, 14(1): 21-28.
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12.	Brat R, Yousef N, Klifa R, et al. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr, 2015, 169(8): e151797.
13.	Rouby JJ, Arbelot C, Gao Y, et al. Training for lung ultrasound score measurement in critically ill patients. Am J Respir Crit Care Med, 2018, 198(3): 398-401.
14.	Steinhorn R, Davis JM, Göpel W, et al. Chronic pulmonary insufficiency of prematurity: developing optimal endpoints for drug development. J Pediatr, 2017, 191: 15-21.
15.	Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med, 2001, 163(7): 1723-1729.
16.	早产儿支气管肺发育不良调查协作组, 容志惠, 常立文, 等. 早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析. 中华儿科杂志, 2011, (9): 655-662.
17.	Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep, 2014, 4: 4340.
18.	Appleby CJ, Towner RA. Magnetic resonance imaging of pulmonary damage in the term and premature rat neonate exposed to hyperoxia. Pediatr Res, 2001, 50(4): 502-507.
19.	Arai H, Ito T, Ito M, et al. Impact of chest radiography-based definition of bronchopulmonary dysplasia. Pediatr Int, 2019, 61(3): 258-263.
20.	Touw HR, Tuinman PR, Gelissen HP, et al. Lung ultrasound: routine practice for the next generation of internists. Neth J Med, 2015, 73(3): 100-107.
21.	Avni EF, Cassart M, de Maertelaer V, et al. Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation. Pediatr Radiol, 1996, 26(7): 463-469.
22.	Pieper CH, Smith J, Brand EJ. The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia. Pediatr Radiol, 2004, 34(3): 227-231.
23.	Onland W, Debray TP, Laughon MM, et al. Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study. BMC Pediatr, 2013, 13: 207.
24.	Clyman RI. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol, 2018, 42(4): 235-242.
25.	Alonso-Ojembarrena A, Lubián-López SP. Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants. Pediatr Pulmonol, 2019, 54(9): 1404-1409.

1. Jobe AH, Abman SH. Bronchopulmonary dysplasia: a continuum of lung disease from the fetus to the adult. Am J Respir Crit Care Med, 2019, 200(6): 659-660.
2. Anderson PJ, Doyle LW. Neurodevelopmental outcome of bronchopulmonary dysplasia. Semin Perinatol, 2006, 30(4): 227-232.
3. Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics, 2010, 126(3): 443-456.
4. High Risk Follow-up Working Group (Kowloon Region). Neurodevelopmental outcomes of extreme-low-birth-weight infants born between 2001 and 2002. Hong Kong Med J, 2008, 14(1): 21-28.
5. Siffel C, Kistler KD, Lewis JFM, et al. Global incidence of bronchopulmonary dysplasia among extremely preterm infants: a systematic literature review. J Matern Fetal Neonatal Med, 2019.
6. Northway WH Jr, Rosan RC, Porter DY. Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med, 1967, 276(7): 357-368.
7. Jobe AH. The new bronchopulmonary dysplasia. Curr Opin Pediatr, 2011, 23(2): 167-172.
8. Lal CV, Ambalavanan N. Biomarkers, early diagnosis, and clinical predictors of bronchopulmonary dysplasia. Clin Perinatol, 2015, 42(4): 739-754.
9. Liu J, Xia RM, Ren XL, et al. The new application of point-of-care lung ultrasound in guiding or assisting neonatal severe lung disease treatment based on a case series. J Matern Fetal Neonatal Med, 2019, online ahead of print.
10. Ehrenkranz RA, Walsh MC, Vohr BR, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics, 2005, 116(6): 1353-1360.
11. 肖甜甜, 金梅, 巨容, 等. 床旁肺部超声在新生儿肺炎中的诊断价值. 中国当代儿科杂志, 2018, 20(06): 444-448.
12. Brat R, Yousef N, Klifa R, et al. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr, 2015, 169(8): e151797.
13. Rouby JJ, Arbelot C, Gao Y, et al. Training for lung ultrasound score measurement in critically ill patients. Am J Respir Crit Care Med, 2018, 198(3): 398-401.
14. Steinhorn R, Davis JM, Göpel W, et al. Chronic pulmonary insufficiency of prematurity: developing optimal endpoints for drug development. J Pediatr, 2017, 191: 15-21.
15. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med, 2001, 163(7): 1723-1729.
16. 早产儿支气管肺发育不良调查协作组, 容志惠, 常立文, 等. 早产儿支气管肺发育不良发生率及高危因素的多中心回顾调查分析. 中华儿科杂志, 2011, (9): 655-662.
17. Zhang Z, Huang X, Lu H. Association between red blood cell transfusion and bronchopulmonary dysplasia in preterm infants. Sci Rep, 2014, 4: 4340.
18. Appleby CJ, Towner RA. Magnetic resonance imaging of pulmonary damage in the term and premature rat neonate exposed to hyperoxia. Pediatr Res, 2001, 50(4): 502-507.
19. Arai H, Ito T, Ito M, et al. Impact of chest radiography-based definition of bronchopulmonary dysplasia. Pediatr Int, 2019, 61(3): 258-263.
20. Touw HR, Tuinman PR, Gelissen HP, et al. Lung ultrasound: routine practice for the next generation of internists. Neth J Med, 2015, 73(3): 100-107.
21. Avni EF, Cassart M, de Maertelaer V, et al. Sonographic prediction of chronic lung disease in the premature undergoing mechanical ventilation. Pediatr Radiol, 1996, 26(7): 463-469.
22. Pieper CH, Smith J, Brand EJ. The value of ultrasound examination of the lungs in predicting bronchopulmonary dysplasia. Pediatr Radiol, 2004, 34(3): 227-231.
23. Onland W, Debray TP, Laughon MM, et al. Clinical prediction models for bronchopulmonary dysplasia: a systematic review and external validation study. BMC Pediatr, 2013, 13: 207.
24. Clyman RI. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity. Semin Perinatol, 2018, 42(4): 235-242.
25. Alonso-Ojembarrena A, Lubián-López SP. Lung ultrasound score as early predictor of bronchopulmonary dysplasia in very low birth weight infants. Pediatr Pulmonol, 2019, 54(9): 1404-1409.

Chinese Journal of Evidence-Based Medicine

The value of bedside lung ultrasound in predicting bronchopulmonary dysplasia in premature infants

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