Application of lung ultrasound in evaluating therapeutic effects of pulmonary surfactants for neonatal respiratory distress syndrome

doi:10.3877/cma.j.issn.1672-6448.2019.10.012

Abstract

Abstract:

Objective

To evaluate the clinical value of lung ultrasound (LUS) in evaluating the therapeutic effects of pulmonary surfactants (PS) for neonatal respiratory distress syndrome (NRDS).

Methods

From May 2018 to December 2018, a total of 37 NRDS newborns admitted at neonatal intensive care unit (NICU) of Tangdu Hospital of the Air Force Military Medical University were prospectively divided into either a therapeutic group or a control group based on the application of PS treatment or not. The therapeutic group included 27 cases treated with poractant α (Curosurf) by endotracheal intubation, and the control group included 10 cases who did not use any PS treatment. Pulmonary ultrasound was performed in both groups after enrollment. The characteristics of ultrasound images and lung ultrasound scores were recorded. In the therapeutic group, the changes of ultrasound images and scores were also observed at 4 h, 1 d, and 3d after treatment.

Results

LUS score in the control group was significantly lower than that in the therapeutic group (11.20±2.10 vs 20.59±5.46, t=-7.561, P<0.001). LUS scores in the treatment group were significantly different among different time points (F=30.453, P<0.001). At 4 h after treatment, LUS score of the examined regions was significantly decreased compared with that before treatment (14.30±4.79 vs 20.59±5.46, P<0.001). LUS score showed no significant changes at 1d after treatment compared with that at 4 h (P=0.389). However, LUS score was significantly lower at 3 d after treatment than at 4 h (9.12±3.45 vs 14.30±4.79, P=0.001). In the control group, LUS images showed mild alveolar interstitial syndrome. However, in the therapeutic group, "white lung" and lung consolidation were noted. At 4 h after PS administration, "white lung" dramatically changed to isolated B lines, and the lung consolidation was significantly reduced.

Conclusion

LUS could be used to early predict whether newborns with NRDS need to be treated with Curosurf, monitor the therapeutic effects in real time, and provide important information for clinical drug use and treatment monitoring of NRDS in NICU.

Key words: Ultrasonography, Lung, Respiratory distress syndrome, newborn, Pulmonary surfactant

Dingyi Wang, Yong Yang, Runrun Yang, Yupin Li, Yunyou Duan. Application of lung ultrasound in evaluating therapeutic effects of pulmonary surfactants for neonatal respiratory distress syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(10): 778-784.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2019.10.012

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References 15

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组别	例数	分娩胎龄（周，±s）	出生体重（kg，±s）	性别（例，男/女）	分娩方式（例，%）		双胎（例，%）	Apgar评分（分，±s）
组别	例数	分娩胎龄（周，±s）	出生体重（kg，±s）	性别（例，男/女）	自然分娩	剖宫产	双胎（例，%）	Apgar评分（分，±s）
治疗组	27	30.81±1.91	1.45±0.40	10/17	13（48.15）	14（51.85）	12（44.44）	7.76±2.43
对照组	10	32.99±1.63	1.94±0.43	5/5	4（40.00）	6（60.00）	4（40.00）	7.90±2.02
统计值（t/χ²）	?	-3.320	-3.452	0.509	0.195		0.059	-0.166
P值	?	0.002	0.001	0.476	0.659		0.809	0.869

组别	例数	分娩胎龄（周，±s）	出生体重（kg，±s）	性别（例，男/女）	分娩方式（例，%）		双胎（例，%）	Apgar评分（分，±s）
组别	例数	分娩胎龄（周，±s）	出生体重（kg，±s）	性别（例，男/女）	自然分娩	剖宫产	双胎（例，%）	Apgar评分（分，±s）
治疗组	27	30.81±1.91	1.45±0.40	10/17	13（48.15）	14（51.85）	12（44.44）	7.76±2.43
对照组	10	32.99±1.63	1.94±0.43	5/5	4（40.00）	6（60.00）	4（40.00）	7.90±2.02
统计值（t/χ²）	?	-3.320	-3.452	0.509	0.195		0.059	-0.166
P值	?	0.002	0.001	0.476	0.659		0.809	0.869

组别	例数	前胸部					侧胸部
组别	例数	正常	稀疏B线	个别肋间密集B线	"白肺"	大范围肺实变	正常	稀疏B线	个别肋间密集B线
对照组	10	2	6	2	0	0	4	6	0
治疗组用药前	27	0	12	2	11	2	3	3	2
治疗组用药后4 h	27	1	19	2	5	0	5	12	4
组别	例数	侧胸部		后胸部
组别	例数	"白肺"	大范围肺实变	正常	稀疏B线	个别肋间密集B线	"白肺"	大范围肺实变
对照组	10	0	0	0	5	5	0	0
治疗组用药前	27	14	5	0	0	2	13	12
治疗组用药后4 h	27	4	2	0	7	6	8	6

组别	例数	前胸部					侧胸部
组别	例数	正常	稀疏B线	个别肋间密集B线	"白肺"	大范围肺实变	正常	稀疏B线	个别肋间密集B线
对照组	10	2	6	2	0	0	4	6	0
治疗组用药前	27	0	12	2	11	2	3	3	2
治疗组用药后4 h	27	1	19	2	5	0	5	12	4
组别	例数	侧胸部		后胸部
组别	例数	"白肺"	大范围肺实变	正常	稀疏B线	个别肋间密集B线	"白肺"	大范围肺实变
对照组	10	0	0	0	5	5	0	0
治疗组用药前	27	14	5	0	0	2	13	12
治疗组用药后4 h	27	4	2	0	7	6	8	6

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