Evaluation of lung ultrasound in the diagnosis of respiratory distress in neonates

Abstract

Background: Respiratory distress (RD) is a leading cause of morbidity and mortality among neonates in neonatal intensive care units (NICUs). Traditionally, clinical criteria combined with chest X-ray have been considered the gold standard for diagnosing respiratory distress. This study aims to assess the efficiency of lung ultrasound in diagnosing respiratory distress, with a focus on preventing neonates from unnecessary radiation exposure. Methods: A multicentric prospective study was performed where neonates with gestational age 28-40 weeks were included based on presence of clinical signs of respiratory distress. Neonates with congenital anomalies or those who received surfactant therapy were excluded. Within 6 hrs of birth, these neonates underwent X ray chest and ultrasound. Final interpretation of chest x-ray was done by the blinded radiologist. A trained neonatologist used transthoracic view in ultrasound for the initial interpretation. Results: A total of 80 neonates were enrolled in the study, among whom 49 were diagnosed with respiratory distress syndrome, 22 with transient tachypnoea of the newborn, 4 with pneumonia, and 5 classified as normal. Lung ultrasound exhibited a sensitivity of 95.9% and a specificity of 90.3% for the diagnosis of respiratory distress, with a positive predictive value of 94% and a negative predictive value of 93.3%. Conclusions: Lung ultrasound proves to be a highly efficient diagnostic tool for respiratory distress in neonates, offering the added advantage of avoiding harmful radiation exposure associated with chest X-rays. Early detection of respiratory distress can facilitate timely management and significantly improve neonatal outcomes. Further adoption and validation of point of care lung ultrasound in clinical practice hold the potential to enhance neonatal care.