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Early lung ultrasound affords little to the prediction of bronchopulmonary dysplasia
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  • Published on:
    The need for adequate methodology to study bronchopulmonary dysplasia using lung ultrasound
    • Almudena Alonso-Ojembarrena, Neonatologist Neonatal Intensive Care Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Puerta del Mar University Hospit
    • Other Contributors:
      • Francesco Raimondi, Neonatologist
      • Daniele de Luca, Neonatologist

    In response to: "Early lung ultrasound affords little to the prediction of bronchopulmonary dysplasia".

    We read with great interest the article by Dr Woods et al (1) that adds evidence to recent, large multicenter studies on lung ultrasound (LUS) as a predictive tool for bronchopulmonary dysplasia (BPD) (2-4). These studies, performed on a total of more than 600 infants, stem from a validated scoring system whose signs represent a progressive decrease in lung aeration in standardized ultrasound views (5). Notably, this approach is also well established in adult critical care (6).
    The grading system adopted by Dr Woods and coworkers, has not been validated and its highest scores do not correspond to less air in the lung and therefore to a more severe pulmonary disease. Also, rather than the conventional sum of scores, Dr Woods et al. calculate a two-decimals mean score that may undermine the technique discrimination. None of these choices have ever been made for any other LUS scores, neither in neonates nor in older patients, despite ultrasound semiology and statistics needed to evaluate the predictive power are always the same (6). These factors may undermine the LUS prediction power for BPD.
    Moreover, the authors needed a full ROC procedure to perform a formal diagnostic accuracy analysis, but even then, its strength would have been questionable with only 7 out 96 infants suffering from moderate-to-severe BPD (7) as target condition. This smal...

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    Conflict of Interest:
    None declared.