Characterization of lung ultrasound imaging in preterm infants with bronchopulmonary dysplasia

Article type: Research Article

Authors: Sun, Ying-Hua^{a; b} | Yuan, Lin^b | Du, Yang^b | Zhou, Jian-Guo^b | Lin, Sam Bill^b | Zhang, Rong^b | Dong, Yi^{c; *} | Chen, Chao^{b; *}

Affiliations: [a] Department of Ultrasound, Children’s Hospital of Fudan University, Shanghai, China | [b] Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China | [c] Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China

Correspondence: [*] Corresponding authors: Yi Dong, MD, Department of Ultrasound, Zhongshan Hospital, Fudan University, Minhang District, Shanghai, China. Tel.: +86 0 21 64041990; E-mail: [email protected]. and Chao Chen, MD, PhD, Department of Neonatology, Children’s Hospital of Fudan University, Minhang District, Shanghai, China. Tel.: +86 (0)21 64931186; E-mail: [email protected].

Abstract: BACKGROUND:Lung ultrasound (LUS) is a bedside technique that can be used on diagnosis and follow-up of neonatal respiratory diseases. However, there are rare reports on the ultrasound features of bronchopulmonary dysplasia (BPD) which is one of the most common chronic lung diseases in preterm infants. OBJECTIVE:To describe the ultrasound features of different BPD levels, and to investigate the value of ultrasound in evaluating moderate-to-severe BPD. METHODS:In this prospective cohort study, newborns of less than 37 weeks’ gestational age in neonatal intensive care unit (NICU) were included. The LUS characteristics including pleural line, alveolar-interstitial syndrome (AIS), retrodiaphragmatic hyperechogenicity and diaphragmatic morphology were observed and recorded. The reliability of LUS in evaluating moderate and severe BPD were compared and calculated. RESULTS:A total of 108 infants were enrolled in our study: 39, 24, 29, 16 infants had non, mild, moderate and severe BPD. The median(IQR) pleura thickness in the moderate-to-severe BPD group was 1.7(1.6–1.85) mm, which was thicker than that in the none-to-mild BPD infants (P < 0.001), meanwhile the proportions of rough pleural lines, diffuse AIS, retrodiaphragmatic hyperechogenicity, small cysts above the diaphragm and rough diaphragm in the moderate-to-severe BPD group were also higher than those in none-to-mild BPD group (86.7% vs 36.5, 57.8% vs 7.9%, 37.8% vs 0, 33.3% vs 0, P < 0.001). In evaluating moderate-to-severe BPD, rough pleura had 91.1% (95% confidence interval [CI]: 0.793–0.965) in sensitivity, 91.3% (95% CI: 0.797–0.966) in negative predictive value (NPV), and 66.7% (95% CI: 0.544–0.771) in specificity. Small cysts had 100% (95% CI: 0.941-1) in specificity, 100% (95% CI: 0.816-1) in positive predictive value (PPV), and 37.8% in sensitivity (95% CI: 0.251–0.524). Rough diaphragm had 100% (95% CI: 0.943-1) in sensitivity, 100% (95% CI: 0.796-1) in PPV and 33.3% (95% CI: 0.211–0.478) in specificity. CONCLUSIONS:Depending on its unique advantages such as convenient, no radiation and repeatable, LUS is a valuable imaging method in assessing the severity of BPD, especially in moderate and severe BPD.

Keywords: Bronchopulmonary dysplasia, lung, preterm infants, ultrasound

DOI: 10.3233/CH-211132

Journal: Clinical Hemorheology and Microcirculation, vol. 80, no. 2, pp. 83-95, 2022