OP05.07: Prediction and utility of neonatal respiratory morbidity by quantitative lung texture analysis in pregnancies at risk for preterm/early term delivery

Abstract

Prediction of neonatal respiratory morbidity can be useful to plan timing and place of delivery in complicated pregnancies and the justification of a first or repeat dose of antenatal corticosteroid in patients at risk for preterm & early term deliveries. This is especially so in resource and access restricted populations. The limited positive predictive performance of current diagnostic tests together with the risks of an invasive procedure, limits the use of fetal lung maturity assessment. This study was undertaken to evaluate the prediction and utility of information provided by a new method of quantitative ultrasound texture analysis (quantusFLM®) of fetal lung maturity in preterm and early term (<39.0 weeks) deliveries. Plans for intervention in pregnancies at risk for preterm and early term deliveries were analysed before and after information from a quantitative test for fetal lung maturity was made available to the clinician. Information was provided to multiple centres from a centralised imaging facility. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation in the 48 hours prior to planned delivery, stored in DICOM format and analysed with quantusFLM®. Perinatal neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, was recorded. The performance of the test in altering decisions of timing and place of delivery and the specificity, negative predictable value of the test to predict neonatal respiratory morbidity were evaluated. A total of 100 patients were assessed. Quantitative textural analysis of the lung predicted neonatal respiratory morbidity with a specificity of 97% and a negative predictive value of 97%. Post test decision making was significantly altered in about one in three patients. quantusFLM® predicted neonatal respiratory morbidity with a higher accuracy than that of previously reported other tests with the advantage of being a non-invasive method.