Lung Ultrasound as a Predictive Tool for Ventilatory Requirements in Neonates with Respiratory Distress: An Observational Study from a Tertiary NICU in South India

Abstract Background Though lung ultrasound (LUS) is a common tool for describing neonatal respiratory conditions, its effectiveness in predicting ventilation needs, especially for late preterm and term neonates with diverse respiratory etiologies, remains less studied [1, 2]. Objective To evaluate the predictive ability of the lung ultrasound score for ventilation requirements in neonates on non-invasive respiratory support. Methods Between July 2021 and June 2023, we conducted an observational study on 192 neonates and included newborns with respiratory distress needing non-invasive respiratory support within 24 hours of birth. The primary outcome was the need for mechanical ventilation within 72 hours of beginning non-invasive support. Results Of the 192 neonates, 31 (16.1%) needed ventilation. The median lung USG (LUS) score was 5 (IQR: 2-7.5) for non-ventilated and 10 (IQR: 7–12) for ventilated neonates. The LUS had a strong discriminative ability for ventilation with an AUC (Area under the curve) of 0.825 (CI: 0.74–0.9, p = 0.0001). An LUS score of > 7 had a sensitivity of 77.4%, a specificity of 75.1%, a positive predictive value (PPV) of 37.5%, a negative predictive value (NPV) of 94.5%, and an accuracy of 75.5% for ventilation needs. On regression analysis, the LUS score predicted the need for ventilation with an odds ratio (OR) of 1.36 (95% CI: 1.2–1.6, p < 0.0001). Antenatal steroid administration (OR: 0.45, 95% CI: 0.12–1.9, p = 0.28), birthweight (OR: 1, 95% CI: 0.9-1.0, p = 0.52), maximum FiO 2 requirement (OR: 1.05, 95% CI: 0.9–1.1, p = 0.06), and the Silverman Anderson score (OR: 1.2, 95% CI: 0.8–1.8, p = 0.3) failed to predict the need for ventilation. Conclusion The study highlights the LUS's capability to predict neonatal ventilation requirements within the first 72 hours of non-invasive support, especially when the score exceeds 7.