الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Respiratory distress is a common cause of neonatal admission in intensive care units, especially in the preterm population, and its clinical and radiological features are often not accurate enough to allow the clinician to predict the patient’s respiratory prognosis. In the last decade, lung ultrasound (LUS) has been increasingly used in critically ill patients and it has become an important tool for neonatologists. It is an easily learned technique with a high inter-observer agreement. It can be performed at the patient’s bedside and is radiation free. Neonates present specific lung diseases with specific sonographic characteristics, which make ultrasound a reliable tool for use by neonatologists. Chest radiography is considered the gold standard test for diagnosis of the leading cause of neonatal respiratory distress, but it is not sufficient to determine the respiratory prognosis.
Continuous positive airway pressure (CPAP) is the first-line therapy for respiratory distress syndrome (RDS), and current international guidelines recommend surfactant replacement only when CPAP fails. Early surfactant administration within the first 2 to 3 hours of life reduces the risk of death and/or bronchopulmonary dysplasia. According to European guidelines, surfactant replacement should be performed when oxygen requirements are increasing. However, arbitrary thresholds of the fraction of inspired oxygen (Fio2) might not accurately reveal the oxygenation status, and Fio2 requirements may be slow to increase, thus delaying surfactant administration well after the best time frame for optimal efficacy.
The main objective of the current study was to test the clinical utility of early lung ultrasound (LUS) pattern and score in a preterm neonate with mild to moderate respiratory distress to predict continuous positive airway pressure (CPAP) failure within the first 24 hours of life.
The current study is a prospective diagnostic accuracy study that was conducted in the NICU of AUCH. We included 120 preterm newborns <34 weeks gestation and admitted for mild to moderate respiratory distress and initially treated with nasal CPAP. LUS was performed within 2-4 hours from nasal CPAP positioning. A chest X-ray was also performed within the same time frame. A LUS risk status and score and an X-ray risk status and score were used and compared. The ability of the scores to predict CPAP failure was evaluated through ROC analysis. Agreement between CXR and LUS risk assessment was done using the kappa test.
Our results could be summarized as:
In our population of 120 preterm newborns with a mean gestational age of 31.11 ± 1.68 and mean birth weight of 1.18 ± 0.27, the incidence of CPAP failure was 20%.
A statistically significant difference as regards the initial CPAP settings (PEEP), initial FiO2 requirements and the product of PEEP and FiO2 >1.28 between the CPAP failure and CPAP success group could be detected.
By comparing the reliability of lung ultrasound with chest x-ray (gold standard) to predict CPAP failure , LUS score showed higher AUC than X-ray score in early recognition of preterm infants with respiratory distress requiring intubation (0.99; 95%CI, 0.978-1003; P < 0.001for LUS vs 0.775; 95%CI, 0.675-0.875;P < 0.001 for CXR). It showed also higher sensitivity (95.83% vs 66.67% respectively), higher specificity (90.62% vs 71.87% respectively), better positive (71.9% vs 37.2% respectively), and negative (98.9% vs 89.6% respectively) predictive values. LUS score was correlated clinically more than the chest X-ray score as regards the need for invasive ventilation, duration of respiratory support and the incidence of complications