Publication:

Beyond B lines: role of pleural line thickness in a novel thoracic ultrasound score for predicting surfactant requirement in preterm neonates

Background Lung ultrasound is a valuable tool for assessing neonatal respiratory distress. Standard lung ultrasound scores (LUS) quantify B-lines, but the role of pleural line thickness, a potential marker of pulmonary edema and inflammation, is less explored. Objective was to assess the diagnostic accuracy of a novel thoracic ultrasound score (TUS), which includes pleural line thickness, in evaluating oxygenation and predicting surfactant need in preterm neonates, compared to the standard LUS.

Methods This prospective study included 80 preterm neonates. After stabilization, infants underwent lung ultrasound (based on Brat et al) and thoracic ultrasound within 3 hours of life. Both the TUS and the standard LUS were calculated.

Results Surfactant was administered to 25 infants (31.25%). These infants had lower gestational age (30.80±3.19 versus 33.56±2.35 weeks, p 34 weeks, TUS showed sensitivity (100%) and NPV (100%). Both scores demonstrated strong correlations with OSI (TUS: r=0.77; LUS: r=0.71, p<0.001) and S/F ratio (TUS: r=-0.76; LUS: r=-0.72, p<0.001).

Conclusions The thoracic ultrasound score, incorporating pleural line thickness, is feasible and accurate tool for early prediction of surfactant need and correlates strongly with oxygenation status in preterm neonates. It performs exceptionally well, particularly in near-term infants.