Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study.
Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment.



The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries.



This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated.



A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively.



The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique.
BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain. Electronic address: mpalacio@clinic.cat.
Montse
M
Palacio
Transmural Biotech SL, Barcelona, Spain.
Elisenda
E
Bonet-Carne
BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain.
Teresa
T
Cobo
Transmural Biotech SL, Barcelona, Spain.
Alvaro
A
Perez-Moreno
BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain.
Joan
J
Sabrià
Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Department of Development and Regeneration, Organ System Cluster, KU Leuven, Leuven, Belgium.
Jute
J
Richter
Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, and Charles University in Prague, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.
Marian
M
Kacerovsky
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg University, Gothenburg, Sweden; Department of Genetics and Bioinformatics, Area of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway.
Bo
B
Jacobsson
Clínica del Prado. Medellín, Antioquía, Colombia.
Raúl A
RA
García-Posada
Division of Fetal-Maternal Medicine, Department of Obstetrics and Gynecology, University Hospital Puerta del Mar, Cadiz, Spain.
Fernando
F
Bugatto
Althaia Xarxa Assistencial Universitària de Manresa, Hospital de Sant Joan de Déu, Manresa, Spain.
Ramon
R
Santisteve
Department of Obstetrics and Gynaecology, Consorci Sanitari de Terrassa, Terrassa, Spain.
Àngels
À
Vives
Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Chile Hospital, Santiago de Chile, Chile.
Mauro
M
Parra-Cordero
Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Wayne State University Detroit, MI.
Edgar
E
Hernandez-Andrade
Division of Maternal and Fetal Medicine, University Hospital La Paz, Madrid, Spain.
José Luis
JL
Bartha
Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
Pilar
P
Carretero-Lucena
Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore.
Kai Lit
KL
Tan
Fetal Medicine Research Unit, Children's and Women's Specialty Hospital of Queretaro, Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, UNAM-Juriquilla, Queretaro, Mexico.
Rogelio
R
Cruz-Martínez
Royal Prince Alfred Hospital Sydney, University of Sydney, Sydney, New South Wales, Australia.
Minke
M
Burke
Fernández Hospital, Hyberabad, India.
Suseela
S
Vavilala
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, University of Wisconsin, Madison, WI.
Igor
I
Iruretagoyena
Fetal Medicine Unit, Clinic University Hospital, Virgen de la Arrixaca, Murcia, Spain.
Juan Luis
JL
Delgado
Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN.
Mauro
M
Schenone
Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra.
Josep
J
Vilanova
BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain.
Francesc
F
Botet
Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore.
George S H
GSH
Yeo
Royal Prince Alfred Hospital Sydney, University of Sydney, Sydney, New South Wales, Australia.
Jon
J
Hyett
Department of Obstetrics and Gynaecology, University Hospitals Leuven, and Academic Department of Development and Regeneration, Organ System Cluster, KU Leuven, Leuven, Belgium.
Jan
J
Deprest
Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Center for Molecular Medicine and Genetics, Wayne State University Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
Roberto
R
Romero
BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (Centro de Investigación Biomédica en Red Enfermedades Raras), Barcelona, Spain.
Eduard
E
Gratacos
D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging* / Q000196:embryology* / Q000473:pathology; D008297:Male; D009017:Morbidity; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology*; D059246:Tachypnea / Q000453:epidemiology*; D016216:Ultrasonography, Prenatal
amniocentesis; amniotic fluid analysis; biomarker; computational methods; diagnostic indices; fetal lung maturity; neonatal respiratory morbidity; predictive values; quantitative texture analysis; respiratory distress syndrome; sonography; transient tachypnea; ultrasound