title: Use of neonatal chest ultrasound to predict noninvasive ventilation failure.
abstract: BACKGROUND
  Noninvasive ventilation is the treatment of choice for neonatal moderate respiratory distress (RD). Predictors of nasal ventilation failure are helpful in preventing clinical deterioration. Work on neonatal lung ultrasound has shown that the persistence of a hyperechogenic, "white lung" image correlates with severe distress in the preterm infant. We investigate the persistent white lung ultrasound image as a marker of noninvasive ventilation failure.
  
  
  METHODS
  Newborns admitted to the NICU with moderate RD and stabilized on nasal continuous positive airway pressure for 120 minutes were enrolled. Lung ultrasound was performed and blindly classified as type 1 (white lung), type 2 (prevalence of B-lines), or type 3 (prevalence of A-lines). Chest radiograph also was examined and graded by an experienced radiologist blind to the infant's clinical condition. Outcome of the study was the accuracy of bilateral type 1 to predict intubation within 24 hours from scanning. Secondary outcome was the performance of the highest radiographic grade within the same time interval.
  
  
  RESULTS
  We enrolled 54 infants (gestational age 32.5 ± 2.6 weeks; birth weight 1703 ± 583 g). Type 1 lung profile showed sensitivity 88.9%, specificity 100%, positive predictive value 100%, and negative predictive value 94.7%. Chest radiograph had sensitivity 38.9%, specificity 77.8%, positive predictive value 46.7%, and negative predictive value 71.8%.
  
  
  CONCLUSIONS
  After a 2-hour nasal ventilation trial, neonatal lung ultrasound is a useful predictor of the need for intubation, largely outperforming conventional radiology. Future studies should address whether including ultrasonography in the management of neonatal moderate RD confers clinical advantages.
authors.affiliation: Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, and raimondi@unina.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raimondi
authors.affiliation: Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, and.
authors.forename: Fiorella
authors.initials: F
authors.lastname: Migliaro
authors.affiliation: Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, and.
authors.forename: Angela
authors.initials: A
authors.lastname: Sodano
authors.affiliation: Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, and.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ferrara
authors.affiliation: Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, and.
authors.forename: Silvia
authors.initials: S
authors.lastname: Lama
authors.affiliation: Division of Pediatric Diagnostics, Department of Biomorphological and Functional Sciences, Università "Federico II," Naples, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Vallone
authors.affiliation: Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, and.
authors.forename: Letizia
authors.initials: L
authors.lastname: Capasso
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D063087:Noninvasive Ventilation / Q000009:adverse effects* / Q000379:methods; D011237:Predictive Value of Tests; D011859:Radiography; D012127:Respiratory Distress Syndrome, Newborn / Q000000981:diagnostic imaging* / Q000628:therapy*; D016037:Single-Blind Method; D017211:Treatment Failure; D014463:Ultrasonography
keywords: distress; lung; neonate; ultrasonography