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Original research
Early lung ultrasound affords little to the prediction of bronchopulmonary dysplasia
  1. Patricia Lee Woods1,2,
  2. Benjamin Stoecklin2,3,
  3. Amanda Woods1,2,
  4. Andrew William Gill1,2
  1. 1 Neonatal Directorate, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia
  2. 2 Faculty of Health & Medical Sciences, The University of Western Australia Centre for Neonatal Research and Education, Perth, Western Australia, Australia
  3. 3 Neonatology, University of Basel Children's Hospital, Basel, Switzerland
  1. Correspondence to Dr Patricia Lee Woods, Neonatal Directorate, King Edward Memorial Hospital Neonatal Clinical Care Unit, Subiaco, Western Australia, Australia; Patricia.Woods{at}health.wa.gov.au

Abstract

Objective To test the hypothesis that lung ultrasound (LUS) performed in the first week of life would predict bronchopulmonary dysplasia (BPD). Secondary outcomes included the utility of LUS in predicting interim respiratory interventions.

Design A prospective observational cohort study in preterm infants born <28 weeks’ gestation in the single tertiary statewide neonatal intensive care unit in Western Australia.

Methods A rigorous protocol for LUS acquisition on day 1, day 3–4, day 7, day 28 and 36 weeks’ postmenstrual age (PMA) was implemented with blinded analysis using a modified, previously validated LUS score. BPD was defined by both recent National Institute of Child Health and Human Development categorical criteria and a continuous physiological variable using a modified Shift test.

Results Of the 100 infants studies, primary outcome data were available for the 96 infants, surviving to 36 weeks’ PMA. In a univariate logistic regression analysis, LUS on days 3–4 and day 7 accurately predicted BPD (day 3–4 OR (95% CI)=1.54 (1.03 to 2.42), p=0.044; day 7 OR (95% CI)=1.66 (1.07 to 2.70), p=0.031). The predictive value of LUS was insignificant in a multivariate model in which gestational age was the dominant predictor. LUS accurately predicted interim respiratory outcomes including surfactant administration, duration of intubation and extubation to non-invasive support at 48 hours.

Conclusions LUS in the first week of life predicted BPD. However, LUS offers little additive accuracy to current gestational age-based models.

Trial registration number ACTRN12617000208303.

  • neonatology
  • technology

Data availability statement

Data are available on reasonable request. Deidentified participant data and Lung Ultrasound Protocol may be available on specific request following corresponding with Dr PLW and agreement of all coauthors.

https://doi.org/10.1136/archdischild-2020-320830

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    Data availability statement

    Data are available on reasonable request. Deidentified participant data and Lung Ultrasound Protocol may be available on specific request following corresponding with Dr PLW and agreement of all coauthors.

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    Footnotes

    • Twitter @tisheewoods

    • Contributors PLW conceptualised and designed the study, acquired and interpreted the data, drafted and revised the manuscript. BS conceptualised and designed the study, acquired the data, interpreted the data, critically reviewed the manuscript. AW acquired the data. AWG conceptualised and designed the study, conducted the statistical analysis, acquired and interpreted the data and drafted and revised the manuscript.

    • Funding This research was supported by The Channel 7 Telethon Trust (SF712) and The University of Western Australia Preterm Centre for Research Excellence.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.