Can lung ultrasound score accurately predict the need for surfactant replacement in preterm neonates?A systematic review and meta-analysis protocol.

Letizia Capasso,Daniele De Luca,Francesco Raimondi,Daniela Pacella,Fiorella Migliaro,Kazumichi Fujioka

doi:10.1371/journal.pone.0255332

Letizia Capasso, Daniele De Luca + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0255332

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Journal: PloS one	Publication Date: Jul 28, 2021
Citations: 6	License type: CC BY 4.0

Affiliation: Federico II University Hospital

Abstract

Respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm infants due to primary surfactant deficiency. Surfactant replacement has greatly improved the short and long term prognosis of RDS but its administration criteria remain uncertain. Lung ultrasound has been recently shown as a non-invasive, repeatable, bedside tool to estimate parenchymal aeration using a semiquantitative score (LUS). The objective of this systematic review and meta-analysis is to evaluate the accuracy of LUS, assessed on the first day of life, to predict surfactant replacement. Methods will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and the protocol has been registered in PROSPERO database (registration number: CRD42021247888). Primary outcome: in a population of preterm infants, LUS will be compared in neonates who received surfactant replacement versus those who did not. Secondary outcome will be the accuracy of lung ultrasound score to predict the need for ≥ 2 doses of surfactant.

Highlights

Respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm infants due to primary surfactant deficiency
Can lung ultrasound score accurately predict the need for surfactant replacement in preterm neonates?
Several groups have shown that a lung ultrasound score (LUS) is a reliable marker to predict the failure of non-invasive support in infants with RDS [5,6,7,8]

Summary

Introduction

Respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm infants due to primary surfactant deficiency. Rather than being a true index of surfactant deficiency, the oxygen requirement threshold is a proxy that depends on the respiratory support delivered to the neonate (e.g. the PEEP level) and on the saturation target. These interdependencies may delay surfactant treatment or lead to unnecessary replacement. Can lung ultrasound score accurately predict the need for surfactant replacement in preterm neonates?. Several groups have shown that a lung ultrasound score (LUS) is a reliable marker to predict the failure of non-invasive support in infants with RDS [5,6,7,8]. The goal is to establish the role of LUS as a clinically relevant tool for surfactant administration as already hypothesized in the 2019 European guidelines on RDS [2]

Methods

Participants

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Study design