Abstract：
Surfactant replacement for respiratory distress syndrome (RDS) is currently guided by oxygen (FiO2) requirement in preterm neonates. Lung ultrasound (LUS) has emerged as an important predictive tool; however, there is a paucity of evidence from developing countries. The objective of this study was to determine the diagnostic accuracy of the LUS score in comparison to standard criteria based on FiO2 requirement for prediction of surfactant requirement. In this prospective study, preterm neonates of < 34 weeks\' gestation with RDS were included within 2 h of life. Surfactant was administered if the FiO2 requirement exceeded 30%. Baseline characteristics, respiratory parameters, and LUS clips were recorded soon after birth and compared between the surfactant and non-surfactant groups. LUS scoring was later performed by masked assessors which was not used in the management of neonates. Among 82 neonates (mean gestation 30.6 weeks and weight 1375 g) included in the study, 33 (40.2%) received surfactant. The surfactant group had a higher Silverman score, required higher FiO2 and mean airway pressure, and needed invasive ventilation more frequently. The mean (± SD) LUS score was significantly higher in the surfactant (9.4 ± 3.2) compared to the non-surfactant group (5.1 ± 2.1). The diagnostic accuracy of LUS scoring was determined by ROC curve analysis (AUC (95% CI): 0.83 (0.74-0.92), p < 0.01). A cutoff score of ≥ 8 for LUS was considered optimal for the prediction of surfactant requirement (sensitivity and specificity (95% CI) of 70% (51-84) and 80% (66-90), respectively). Conclusion: Lung ultrasound is a valid diagnostic tool for the prediction of surfactant requirements in resource-limited settings. What is Known: • Lung ultrasound has a good diagnostic accuracy in predicting the need for surfactant administration in preterm neonates in developed countries, but its role in developing countries is unclear. What is New: • Lung ultrasound proved to be a valid diagnostic tool in predicting surfactant replacement therapy in resource-limited settings. • The diagnostic performance of lung ultrasound was better in neonates on non-invasive ventilation, compared to invasive ventilation.
摘要：
目前，早产儿需要氧气（FiO2）来替代呼吸窘迫综合征（RDS）。肺超声（LUS）已成为一种重要的预测工具；然而，发展中国家缺乏证据。这项研究的目的是确定LUS评分与基于FiO2需求的标准标准相比的诊断准确性，以预测表面活性剂需求。在这项前瞻性研究中，出生后2小时内纳入妊娠<34周的RDS早产儿。如果FiO2需求超过30%,则施用表面活性剂。基线特征，呼吸参数,出生后不久记录LUS片段，并在表面活性剂和非表面活性剂组之间进行比较。LUS评分后来由蒙面评估员进行，未用于新生儿的管理。在82名新生儿（平均妊娠30.6周，体重1375g）中，33(40.2%)接受表面活性剂。表面活性剂组的Silverman评分较高，需要更高的FiO2和平均气道压，需要更频繁的有创通气。表面活性剂组的平均(±SD)LUS评分(9.4±3.2)显著高于非表面活性剂组(5.1±2.1)。通过ROC曲线分析确定LUS评分的诊断准确性（AUC（95％CI）：0.83（0.74-0.92），p<0.01)。LUS的截止分数≥8被认为是预测表面活性剂需求的最佳选择（敏感性和特异性（95％CI）为70％（51-84）和80％（66-90），分别)。结论：在资源有限的环境中，肺部超声是预测表面活性剂需求的有效诊断工具。什么是已知的：•肺超声具有良好的诊断准确性，预测需要表面活性剂在早产新生儿在发达国家，但它在发展中国家的作用尚不清楚。新增内容：•肺部超声被证明是在资源有限的环境中预测表面活性剂替代疗法的有效诊断工具。•在新生儿无创通气时，肺部超声的诊断性能更好，与有创通气相比。
